HAJJ – Pilgrimage to the House of Allah in Mecca

1. Introduction

Hajj or pilgrimage to Mecca is one of the five pillars of Islam. Hajj was made obligatory in the 9th year of Hijra. The Holy Prophet sent off 300 Muslims under the leadership of Hazrat Abubakr Siddique (may Allah be pleased with him) to Mecca so that they could perform Hajj. That was the year when it was banned for the Mushrikeen (those who associate partners with Allah) to enter Ka’ba. It was also made unlawful to perform Tawaaf (circling of Ka’ba) with naked body.


The following year, 10th Hijra, the Holy Prophet (peace be upon him) announced a head of time he himself would perform Hajj that year. He led tens of thousands of Muslims to Hajj that year and demonstrated to Muslims how to perform all the rites and rituals of the Hajj. This Hajj is known in history as Hajjatul Wida’ or Farewell Pilgrimage because this proved to be the last Hajj the Holy Prophet (peace be upon him) performed. At the end of this farewell pilgrimage, the divine revelation that had started some 22 years ago came to an end with the following verse of Surah Al-Maidah:


“This day have I completed My commandments for you, and have brought to its fullness the favor that I have bestowed upon you, and have chosen Islam as your religion”


.Hajj is an act of worship just like Salat (five daily prayers) and Sawm (fasting in the month of Ramadan). Muslims from all over the world gather in Mecca in the last month of Muslim calendar and worship Allah. Hajj is a special worship that lasts for several days. This is an occasion that brings Muslims of all countries, colors, and races to one place – the Ka’ba. This is a unique opportunity of worshipping Allah collectively in a large gathering at one place.c


2. Significance & Philosophy of hajj


Every nation and society has a center of unity where they get together to worship God. They see prosperity and culture as relics of unity. People of the society get to know each other and understand each other’s difficulties. They form a unified front to remove these difficulties and achieve their goals. Allah says in the Holy Quran: “And to every people We appointed rites of sacrifice, that they might mention the name of Allah…” (22:34)


With this idea, Hajj has been made a pinnacle of worship in order that Muslims who gather to perform Hajj can praise their Lord and Master, be thankful for His blessings, and humbly pray to Him for the removal of their difficulties. Muslims living in various parts of the world get to know each other, lay the foundation of social culture, give advice to each other, and provide opportunity for collective struggle.


3. Upon Whom Is It Obligatory To Perform Hajj


An adult Muslim of a sane mind, an able body and having means to bear the expenses must perform this act of worship once in his/her lifetime. There should be peace on the way to Mecca and there should be no hindrance or restriction in traveling to Mecca. Hajj is not obligatory for children, the sick, and those who are unable to bear the expenses for Hajj.


4. What are the Timings of Hajj (Pilgrimage)


There are specific months for performing the Hajj and are called “Months of Pilgrimage.” These three Islamic months are Shawwal, Ze-Qa’d and Dul-Hajj. During these three “Months of Hajj”, one prepares for the pilgrimage, attains good morals, and completes other physical conditions for the pilgrimage. All the essential duties of the pilgrimage have to be completed between 8th and the 13th day of Dul-Hajj. Additional tawaaf (circling around the Ka’ba), however, may be performed until the end of the month of Dul-Hajj.




5. Pillars of Hajj


There are three basic pillars for performing Hajj:


1.To enter into state of “Ihram” and have the intention to perform the pilgrimage.


2.To stay at the field of “Arafat” on the ninth of Dul-Hajj If someone cannot go to the field of Arafat even for a short time then his/her pilgrimage will not be complete. He/she has to perform the pilgrimage again the following year.


3.Additional circling of the “Ka’ba” that is done after the stay at the field of “Arafat” and performed from the tenth to the end of the month.


6. Sequence of Rites and Actions for performing Hajj:




A. Departure From Home


A Muslim must be mindful of his/her duties towards family and fellow human beings. A Muslim who intends to perform Hajj must make sure, before departing for Hajj that his family is provided for during the period he is away for the Hajj. He should pay up his debt and seek forgiveness from fellow human being whom he might have caused harm in the past. He should be diligent in observing Salat (five daily prayers) and Sawm (fasting) in the month of Ramadhan as well as carrying out other religious obligations. He must shun all arrogance and exhibit a character of modesty and humbleness. He must not use unlawfully acquired money or unlawful means to perform Hajj. He should seek sincere repentance from Allah of all his past sins. In short, one should depart for Hajj just like one would wish to depart from this world.


One should spend some money in charity as well. A woman is not allowed to perform Hajj alone and must be accompanied by an adult Muslim Mahram (father, husband, son or brother etc.)


One should say two Rakat Nafl (supererogatory) prayer before leaving home for Hajj.


B. Ihram at Miqat


When one reaches “Miqat” (any one of the appointed places in Mecca where pilgrims make a vow of pilgrimage) one must perform ablution or take a bath, use perfume, and put on two clean, unstitched, preferably white, pieces of cloth. This pair of clothing is called Ihram. One sheet should be wrapped around the lower part of the body and the other sheet around the upper body; the head should not be covered. Women can perform pilgrimage in the cloths they are wearing. Under normal circumstances a woman’s face should not be covered unless she comes face to face with a stranger and she has to conceal herself. During the five days of Hajj, all Muslims engaged in this worship must remain in this same simple dress. As soon as a pilgrim puts on Ihram and declares his intention to perform Hajj, he/she enters into the state of Ihram and his/her Hajj begins.


C. Talbiyah


After putting on the Ihram, men and women offer two Raka’ts of Nafl (supererogatory) prayer followed by recitation of their “intention” and saying the following words:
“Labbaik Allahumma Labbaik; La Shareeka-laka Labbaik; Innalhamda wan-na’mata-laka wal-mulka Lashreeka-laka"
Translation:
“Here I am, O Allah! Here I am in Thy August presence; there is no associate with Thee, here am I; surely all praise is Thine and all favors are Thine and the kingdom is Thine, there is no associate with Thee.”
These words are recited in Arabic and called “Talbiyah”. These words are an essential part of the state of Ihram and Ihram will not complete without reciting these words. After saying Talbiyah pilgrim is ready to fulfill his obligation of Hajj and is required to fulfill all the conditions laid down for Hajj. While one is in the state of Ihram it is strictly forbidden to engage in foul talk, sexual conduct, arguments, or enter into a war. Allah says in the Holy Quran: “ …so whoever determines to perform the Pilgrimage in these months, should remember that there is to be no foul talk, nor any transgression, nor any quarreling during Pilgrimage. …” (2:198)


D. Entering Masjid-el-Haram


After reaching Mecca, one should head straight to Ka’aba that is situated in bounds of Masjid-el-Haram and perform Tawaaf. It is said that when one has his/her first glance at Ka’aba, whatever prayers one makes is granted.


E. Istlam (Kissing the Hajr-e-Aswad)


The act of kissing the Hajr-e-Aswad (Black Stone) is called Istlam. While kissing the Hajr-e-Aswad, ones hands should be on the wall of the Ka’ba in the same position as when one performs a Sajdah (prostration) during a prayer. If it is not possible to kiss the Hajr-e-Aswad, it is permissible just touch it with a hand and if that is not possible the just point to the Hajr-e-Aswad and blow a kiss to it.


F. Tawaaf (Circling of ka’ba)


After performing Istlam (kissing the Hajr-e-Aswad) as described above, a pilgrim should perform Tawaaf of Ka’ba. Tawaaf is performed by going around Ka’ba seven times keeping the Ka’ba on left hand side (counter clock-wise). Istlam should be performed during each circle. It is also permitted to perform Istlam of Rukun-e-Yemeni (Pillar of Yemen). The seventh circle ends at the Hajr-e-Aswad.


G. Nawafal at Muqam-e-Ibrahim


After completing the Tawaaf, the pilgrim should move to the Muqam-e-Ibrahim (Place of Ibrahim. At this place one should offer two Rakats of prayer while facing Ka’ba.


H. Sa’ee (Running between Safa’ and Marwah)


Allah the Exalted has said the Holy Quran:


“Surely, Al-Safa and Al-Marwah are among the Signs of Allah. It is, therefore, no sin for him who is on pilgrimage to the House, or performs Umra, to go round the two. And whoso does good beyond what is obligatory, surely then, Allah is Appreciating, All-Knowing.” (2:159)


After praying two Rakats of prayer at Muqam-e-Ibrahim, the pilgrim then moves to “Safa”. At this place, he should face towards Ka’ba and recite Durood, Takbir and Talbiyah. The he should walk briskly towards Marwah and recite the same at Marwah. This counts as one circuit. Now one should move to Safa’ and repeat the prayers. One should complete seven circuits between Safa’ and Marwah. These circuits are called Sa’ee.


After performing the circuits between Safa’ and Marwah, one is free to move about and go to a resting place.


I. Arriving at Mina


On 8th day of Dul-Hajj the pilgrims reach at Mina early in the morning after performing Tawaaf-Qudoom. A pilgrim offers Duhr, Asr, Maghrib and Isha’ prayers at Mina and camp there for the night.


J. Arriving at Arafat


On 9th day of Dul-Hajj, after offering Fajr prayer, a pilgrim should move to Arafat. Stay at Arafat is called Waqoof and is the most important part of Hajj. Without this, Hajj cannot be considered complete. If someone misses Waqoof, he should perform Hajj the following year. One listens to the sermon at the plane of Arafat and offers combined Zuhr and Asr prayers. One should stay at Arafat till sunset (Maghrib).


K. Arriving at Muzdalifah


One leaves Arafat after sunset and reaches Muzdalifah in the evening of 9th Dul-Hajj. Combined Maghrib and Isha’ prayers are offered at Muzdalifah. The pilgrims spend the night at Muzdalifah.


L. Departure from Muzdalifah


On the 10th day of Dul-Hajj the pilgrims offer their Fajr prayer as early in the morning as possible. After the Fajr prayer a pilgrim leaves Muzdalifah and arrive at Mina. On the way to Mina one should pick up seventy small stones. As soon as he reaches Mina, he should cast seven stones at Jumrah-tul-Aqba. This act of throwing stones is called Rami. With the throwing of the first stone the requirement to repeatedly recite Talbiyah is lifted. If the pilgrim intends to sacrifice an animal then he should do that after casting stones ad Jumrah-tul-Aqba. After offering the sacrifices a male pilgrim should have his head shaven and female pilgrims are required to cut a small part of her hair. Femle pilgrims are not permitted to have their heads shaven. After the hair cut one can remove the Ihram and may now wear regular cloths.


M. Return to Mecca after sacrifice and hair cut. Perform Taawaf-e-Afaza


After the removal of Ihram the pilgrim is required to return to Mecca to perform another circuit of the Ka’ba. This particular circuit is called Tawaaf-e-Afaza (additional circuit) and is an essential part of the pilgrimage. After this circuit a pilgrim is permitted to return to normal life and all those lawful things that were forbidden are now allowed again.


N. Return to Mina after Tawaf-e-Afaza


After this additional circuit, the pilgrim should return to Mina and stay there for three days. During the stay at Mina on 11th, 12th and 13th day of Dul-Hajj the pilgrim cast seven stones on each of the Jumrah in the following order: Jumrah-tul-Oola, Jamrah-tul-Wusta, and Juramh-tul-Aqba. It is permitted not to cast stones on the third day.


O. Return to Ka’ba and Farewell


On the 12th or the 13th day of Dul-Hajj, the pilgrim returns to the Ka’ba and perform a final circuit. This circuit is called Tawaf-al-Sadr or Tawaf-al-Wida (parting or farewell circuit). After this last circuit, the pilgrim should drink water from Zumzum, kiss the threshold of the door of the Ka’ba, and pray to Allah for forgiveness. He should leave the Ka’ba walking backwards, looking at it the last time, and saying farewell.


7. Prohibitions During the Pilgrimage


It is forbidden to have a hair cut during Hajj or to wear sewn clothes. Pilgrims should offer Fidya (redemption) if he has to wear sewn clothes or have to shave his head due to illness or lice.


Hunting is forbidden during the pilgrimage days. If the pilgrim hunts during these days then he has to offer the sacrifice of one animal. If he has hunted deer then a lamb should be sacrificed and of ostrich is hunted then camel should be sacrificed. If one cannot offer a sacrifice the he should feed six poor people and if that is not possible the he should fast for three days. Allah says in the Holy Quran:


“O ye who believe! Kill not game while you are in a state of pilgrimage. And whoso amongst you kills it intentionally, its compensation is a quadruped like unto that which he has killed, as determined by two just men from among you, the dame to be brought as an offering to the Ka’ba; or as an expiation he shall have to feed a number of poor persons, or fast an equivalent number of days, so that he may taste the penalty of his deed. As for the past, Allah forgives it; but whoso reverts to it, Allah will punish him for his offense. And Allah is Mighty, Lord of retribution.


The game of the sea and the eating thereof have been made lawful for you as a provision for you and the travelers, but forbidden to you is the game of land as long as you are in a state of pilgrimage. And fear Allah to Whom you shall be gathered.


Allah has made the Ka’ba the inviolable House as a mean of support and uplift of mankind, as also the Sacred Month and the offerings and the animals with collars. That is so that you may know that Allah knows what is in the heavens and what is in the earth, and that Allah knows all things well.


Know that Allah is sever in punishment and that Allah is also Most Forgiving, Merciful.” (5:95-98)


If the pilgrim has sexual intercourse with his/her spouse before the first Tawaaf the Hajj will become invalid or unlawful. He/she should continue to perform all the duties of the pilgrimage but he/she has to perform pilgrimage again the next year. Moreover he/she has to sacrifice a camel at Mina to atone the violation.


8. Ahsari


If some difficulty arises after entering the state of Ihram for the Hajj or Umra (i.e., illness, resistance by enemy to prevent from reaching Mecca) then the sacrifice of an animal should be offered and the Ihram removed. We read in the Holy Quran: “ … but if you are kept back, then make whatever offering is easily available; and do not shave your heads until the offering reaches its destination … “ (2:197).


9. Umra


To simply circuit the Ka’ba and perform the seven circuits between Safa and Marwah is called Umra. There is no fixed time for Umra and it can be performed at any time during the year except between the 9th and the 13th of Dul-Hajj (these days are only reserved for the full pilgrimage or Hajj). Entering into the state of Ihram and removal of Ihram is carried out in the same manner as for the full pilgrimage.


10. Types Of Hajj:


There are three types of Hajj:


a. Hajj Mufrad:


All conditions of the Hajj Mufrad are same as described above. One enters into the state of Ihram for Hajj only and no Umra is performed before Hajj.


b. Hajj Tamattu :


This is Hajj when Umra is performed before the Hajj. The pilgrim removes Ihram for Umra on the 8th of Dul Hajj and re-enters into the state of Ihram again for Hajj.


c. Hajj Qiran:


In this Hajj, the pilgrim enters into the state of Ihram for both Umra and the Hajj at one time.


11. Places of Hajj inside Mecca


A. Ka'aba:


The focus of the pilgrimage is Ka’ba which was rebuilt by Prophet Ibrahim (peace be upon him) some 4000 years ago. Today, Ka’ba stands in the middle of a large courtyard of Masjid-el-Haram or the sacred Mosque. The courtyard of Masjid-el-Haram contains, besides Ka’ba, the Muqam-e-Ibrahim (place of Ibrahim) and the fountain of Zumzum.


Ka’ba is the first house ever that was built for the worship of One and Only God, Allah. It is also called “Bait-Ullah” (House of Allah), “Bait-ul-Ateeq” (the Oldest House), and Baitul Ma’amoor (Inhabited House).


Muslims, all over the world, face towards Ka’ba to offer their prayers. This house and the places around it have several signs that have been manifested by Allah. Every inch of this land testifies to the fact that Allah never destroys those who offer sacrifices. To commemorate Allah’s signs and to enhance their faith that Allah truly fulfils His promise, Muslims have been ordered to pay homage to the Ka’ba and these other Signs of Allah. Allah the Exalted, says in the Holy Quran:



“Surely, the first House founded for mankind is that at Becca (the valley of Mecca), abounding in blessings and a guidance for all peoples. In it are manifest signs; it is the place of Abraham; and whoso enters it, enters peace” (3:96-97)


Hadrat Ibrahim (peace be upon him) laid a foundation stone for a community in a deserted place by the order of All-Mighty Allah. The he settled his wife, Hajira, and his son, Ishmael, at this place. There was no water at this place and it was not a part of any thoroughfare. The ultimate goal of this unparalleled sacrifice was that his place should serve as a center of universal guidance; that from the progeny of Hadrat Ishmael living in this area would come the greatest prophet whose advent marked the sole cause for the creation of this universe and who would be a mercy for all mankind. The teaching that he brought down would be for the entire world and for all times. In spite of having no sign of any provisions at this place, Hadrat Ibrahim’s (peace be upon him) expectations were superceded. Allah made provisions for water at that place. Slowly the place became populated and was called Becca or Mecca. This was the place where Hadrat Ibrahim (peace be upon him) found lost signs of the first House of Allah that was built for His worship and re-built this house with the help of his son. He fervently prayed to Allah to make this house the “Place for Humanity”.


B. Hajr-e-Aswad (The Black Stone)


There is a black stone in the north-eastern corner of the Ka’ba. This stone is called Hajr-e-Aswad (Black Stone). This stone was probably part of a meteoroid that fell near Mecca on a mountain called Abu Qubais. At the time of construction of Ka’ba, Hadrat Ibrahim brought it down and placed in the corner of the Ka’ba as a great sign and a monument. Anyone who performs pilgrimage is expected to kiss this memorial stone. This stone is part of Allah’s mark and is a sign of Him being the Supreme Being. One loves things that belong to one’s beloved. The same philosophy exists behind kissing the stone. This stone has no power and it provides neither benefit nor harm to anyone.


C. Hateem


A short distance away from Ka’ba towards North there is an open space.The place has small walls around it but there is no ceiling.There is a tradition of the Holy Prophet (peace be upon him) that suggests that this place was left without a roof because not enough wood was available to cover the entire building.A pilgrim should keep this place inside the Tawaaf but it is not right to face towards this place when offering prayers.


D. Multazam


The southern part of the wall between the door of the Ka’ba and the black stone is called Multazam. At the completion of the pilgrimage the pilgrims embrace this part of the wall. This is one way of saying good-bye and a way of expression of extreme love for the House of Allah.


E. Rukun-e-Yemeni


The north-western corner of the Ka’ba faces towards Yemen and this is why it is called Rukun-e-Yemeni (Yemen’s Pillar). It is not appropriate to touch or kiss this part during making a circuit of the Holy Ka’ba.


F. Mutaaf


There is a circle of white stone around the Ka’ba. This is the place where the circuit of the Holy Ka’ba is performed during the pilgrimage. The circuit of the Holy Ka’ba is an integral part of the worship offered seven times during Hajj.


G. Muqam-e-Ibrahim (Place of Ibrahim)


There is a small round-shaped building in front of the door of the Ka’ba and the Multazam. This building has a stone that was used by Hadrat Ibrahim to stand on to complete the walls of the Ka’ba. This is called Muqam-Ibrahim (Place of Ibrahim). After completing the seventh circuit during the pilgrimage, two Raka’t of prayer are offered. One gets more blessings if these Raka’ts are offered at the Place of Ibrahim.


H. Zumzum


A small well is present on the left side of the Place of Ibrahim and to the east of the Ka’ba. This well appeared as a sign when the child Ishmael rubbed his heels on the ground due to his thirst. One drinks water from this well facing the Ka’ba to get blessings.


I. Masjid-el-Haram


Around the Ka’ba is a mosque that has a rectangular shape with rounded corners. Pilgrims offer prayers in this mosque by making circular rows and face towards the Ka’ba.


J. Al-Safa and Al-Marwa


Two small hills in Mecca were located in the north of Masjid-el-Haram. Now these hills have been flattened. Hadrat Hajirah ran seven times between these two hills in search of food and water. Pilgrims are ordained to follow her footsteps and go to these hills seven times.


12. Places Outside of Mecca


A. Mina


There is an open ground three miles to the east of Mecca called Mina. There are three stone pillars in this ground that are called Jumrat representing Satan. These stones are called Jumrah-tul-Oola, Jumrah-tul-Wusta, and Jumrah-tul-Aqbah. During the last day of Hajj, the 10th Dul-Hajj and three Tashriq days, pilgrims are required to cast stones at these Jumrah. This act of casting stones at Jumrah is called Ramy al-jimar (throwing small stones). Thousands of animals are sacrificed on this ground to commemorate the great sacrifice of Hadrat Ibrahim and Hadrat Ishmael.


B. Arafat


On the 9th day of Dul Hajj pilgrims gather in a great ground that is located about 9 miles to the southeast Mecca. This ground is called Arafat. Pilgrims stay at this place from the time of Duhr prayer until Maghrib. Jabalu-Rahmat is a small hill that also stands on this ground. A pilgrim is required to stay at this ground for his/her pilgrimage to be acceptable.


C. Muzdalifah


This ground is located roughly three miles from Arafat towards Mina. A small hill Mash’ar-al-Haraam is present in this field. Pilgrims spend the night of 9ht Dul Hajj in this field on their way back from Arafat. They offer Maghrib and Isha prayers combined and then Fajr prayer on the morning of the 10th day of Dul Hajj at this place. Pilgrims are commanded to remember Allah after the Fajr prayer near the mountains of Mash’ar-ul-Haraam.


D. Muwaqiat


Muwaqiat is the plural of Miqat. This is the place where pilgrims enter into the state of Ihram. It is forbidden to go any further from this place without entering the state of Ihram. Ihram is not only wearing specific clothing but it is also a sincere intention to perform the pilgrimage. There are several placed to enter into the state of Ihram that are marked as Miqat depending upon the route taken towards Mecca. Following are the well-known places where the Pilgrims enter into the state of Ihram.


a. Mecca


Pilgrims who live in and around Mecca enter into the state of Ihram in their homes. People can enter into the state of Ihram before leaving their homes. It is not absolutely necessary for “local” pilgrims to enter into the state of Ihram at the Mawaqit, however, it is forbidden to proceed any further from these place without being in the state of Ihram for the people coming from other locations.


b. Dul-Hulaifah:


Five miles from Madina towards Mecca is a small village. Pilgrims arriving from Madina and from its surrounding areas are required to replace their usual clothes with Ihram at this place


c. Juhfah


This place located about forty miles to the south of Mecca. Pilgrims arriving from Egypt, Syria and Southern Africa are required to enter into the state of Ihram at this place.


d. Zaat-ul-Irq


Located about thirty miles from Mecca, the pilgrims coming from Iraq and by land from the eastern side enter into the state of Ihram at this place.



e. Qarn-al-Manazil


Located about 40 miles to the east of Mecca, the Pilgrims arriving from Yemen and by sea enter into the state of Ihram at this place.



f. Taneem


This place is near Mecca and acts as Miqat for people living in Mecca. If someone is living in Mecca and wants to perform Umra then he should go to this place, enter into the state of Ihram and then return to Mecca so that the condition of traveling for the pilgrims is also fulfilled. The Holy Prophet (peace be upon him) has said: “Part of the worship of Hajj and Umra is to travel in the way of Allah and to go out of the city.”


E. Haram

Mecca and its surrounding areas are called Haram. Haram has different boundaries. These boundaries extend to three miles on one side, seven on the other and nine miles towards Jedda. Within these boundaries of Haram it is forbidden to hunt, bother any animal, or to cut grass or trees. One is permitted to kill dangerous animals like snakes, scorpions, rats or animals with rabies (dogs, etc.)

REMEMBERING MY BELOVED FATHER....!

By M H Ahssan

I originally wrote this memorial death poem in September last year as part of an art and poetry collection that I was developing. The original poem was inspired by an abstract 'web history painting' that I had named "My Fathers Mask". Then today as I got ready to post the original poem on my blog I realized that it was February 26, the anniversary of my father's death. You may call it coincidence if you wish, but I do not believe in coincidences. So I decided to rewrite the original poem as a memorial poem in honor of my late father.

My intention in creating this lens is to remember my father and at the same time bring comfort to those of you who are grieving the death of a loved one. I hope that the inspirational memorial poems, fathers death quotes and memorial gifts in this lens are of some help to you. This memorial poem is titled, "My Fathers Mask: Death the Journey Home." and it is dedicated to my dear father, the late Mohammed Ahsanuddin Akhter, who passed away on Fenruary 26, 2010. He was a special man and a wonderful father and I thank God for blessing me with such a great dad.

He did not have a mask in his study but he had plenty of books and he loved to read and learn. He passed this love for the written word on to all of us and he always said that knowledge was the one thing that nobody could take away from you. Two of my father's favorite poems that I cherish to this day are "Allama Iqbal verses on his mother's death & Creation of my father on his mother's death." These two inspirational poems encourage me and keep me going whenever my spirits are low. I find solace in reading my fathers favorite poems and I know that even if he is gone from this world he is still watching over me. Rest in Peace, dear Papa, you will always be loved and cherished. 

I fully beleive in the great words, "When you follow in the path of your father, you learn to walk like him." ~ May god bless his soul into peace. Ameen!

Celebrations galore at India Inc.

This Diwali, India Inc made sure their employees celebrated the festive times with much meaning and cheer. Newsindia tells you how they did it like never before.

Cash, contests and celebrations
This year, British Telecom celebrated Diwali with a special theme of CASH – celebration, affection, smiles and health. The celebrations bundled with games, ethnic dress contests, creative office decorations and loads of special prizes made the work place more lively, personal and engaging for our employees. They also celebrated an entire day as ‘Affection Day' at BT when everyone on the floor appreciated the work of their peers/managers and expressed their gratitude. Employees were encouraged to do cross-functional appreciation by appreciating the work of other teams. Employees also showed affection to each other by presenting flash cards as per the category of recognition.

Traditional celebrations
Ingersoll Rand conducted a special Lakshmi Puja in the office and along with various games and competitions employees took time out to decorate their desks with colours and diyas. The best-decorated workstation won a prize. To help make a special Diwali for the less fortunate, they went a step further and tied up with a local NGO. The NGO setup its stall in the office and sold innovative items made by inmates of Tihar Jail. Employees enjoyed their shopping spree, getting to choose from crochet bags, purses, mobile covers, Leather woven visiting card holders, jewellry boxes etc. The money collected from the sale of the items went to the Children of Vulnerable Societies (children of the inmates studying in government / mcd schools).

The magic of cinema
Uninor organised a film festival this Diwali, wherein screening of different popular films for all employees at the corporate office was done. In addition to this, we gave out Diwali gift cards to all our on-and-off role employees. With this, was a personal thank you card from the MD, which was developed together with Literacy India, our NGO partner. We also sent out handmade items from Literacy India as gifts to all employees and partners.

Spirit of celebrations
The festive celebrations at Deloitte commenced with partnering with several NGOs like Khushi, Himjoli, Arunim, Hope Worldwide India and Calcutta Marudyan by encouraging our people to buy goods manufactured by these NGOs. As an organisation, we distributed gifts and sweets to all our colleagues. To enable our colleagues and their families to bond with each other, we organised events, which brought out the best in them. We organised team competitions for our people. This year, we also explored organising events for family members. We had team competitions for our employees' spouses as well as for their children. We encouraged our people to sell whatever they want to and contribute the sales proceeds towards charity.

Joys of serving
Since Convergys is celebrating ten years of successful operations in India in the month of October, 2011, Diwali was a time for celebration, recognition and fun at work. We also celebrated the ‘customer service week', a global initiative to acknowledge the contribution of our employees who we recognise and reward as ‘customer service idols'. During the Diwali week, Convergys organised themed skits to portray unique customer service skills that fetch us greater customer satisfaction scores. Convergys decided to make a contribution to the Blind School at Maneswar during the 10-year celebrations as a part of its CAN initiatives.

'Diverse' Festivities

A culturally diverse workforce often tends to bring out a fresh perspective to the table. Here's why such a workforce stands apart from the rest.

Though cultural diversity is an important aspect, it is often ignored at the workplace level. Every company is a mesh of employees coming from different religions, locations, communities and cultures. The more the variety, the more challenging it is for the employees to adjust with each other; but once they get past these differences, this cultural diversity can prove very beneficial for the organisation and its productivity. The range of people working together can bring an all-new dimension to the creativity and decision-making process in the company.

Jayan Narayanan, AVP and head, corporate marketing and communications, CSS Corp, tells us the benefits that an organisation can derive from its cultural diversity, "A culturally diverse workforce implies that we meet people with vivid experiences, ways of articulation and communication. This makes interaction within the organisation more diverse, thus making the shop floors more productive and buzzing with activity. In terms of productivity, this diversity helps tackle difficult situations and makes ideation more diverse. Employees tend to automatically tune themselves to be more diplomatic while communicating, which in turn, helps in improving client interactions to a large extent."

However, a diverse workforce poses many challenges for the company as well that must be tackled with care. Ulhas Chandratre, AVP, HR, Sanghvi Movers Ltd, elaborates, "Sometimes, cultural diversity among employees leads to communication gaps and consequently, a problem in understanding and team-work. Problems in co-ordination between the head-office team and on-site employees can sometimes lead to issues. We also face the problem of absenteeism during regional festivals. Cultural prejudices and shocks are other major hurdles."

So how can a company make its workforce more diverse? Dinesh Rai, associate VP - HR, Mindteck, answers, "An organisation should sensitise its workforce to respect cultural differences by providing diversity training. Accommodating cultural and festive holidays and flexible schedules are some more ways an organisation can adopt to make its workforce diverse."

Whatever the route, cultural diversity among employees can go a long way in increasing the innovation levels and improving organisational productivity.

The Fermenting India

India these days seems to be in ferment. If one picks up a newspaper one gets hit by headlines that certainly do not bode well for the country, at least, not in its immediate future. While one can discern a severe churning taking place in the country’s social, political and economic life, the government, at the same time, is largely perceived to be drifting along.

Protests against governmental actions/inactions both, at the Centre and in some states have been raging for months. Tamilnadu in the South has witnessed an agitation against the Koodankulam nuclear power plant that is only few months away from attaining criticality. The pathetic fate of far-away Fukushima in Japan and its ill-fated victims have justifiably induced fear in the surrounding villages of Koodankulam. People in general have become resistant to the idea of nuclear power and fearful of the nuclear power plants.

Another anti-nuclear protest by villagers earlier this year in the idyllic Konkan region in Maharashtra’s Ratnagiri District against a mega Nuclear Power Park had boiled over for weeks and had even become violent. Acquisitions of fertile lands under an antique law for mining, industry and power – thermal or nuclear – in pursuit of double-digit GDP growth gave rise to agitations of farmers and tribal communities in several states. The government has been hard put to subdue them.

The country has also seen protests in the North-East, in Arunachal Pradesh and Assam, as also in the Himalayan states of Himachal and Uttarakhand against construction of dams for irrigation and generating hydro-power. While people, especially rural and tribal communities, have become more alert about safeguarding their rights and livelihoods, the governments, both at the Centre and in the states have been tardy in shedding their autocratic attitudes and have failed to take people into confidence before conceiving projects that impinge on their wellbeing.

Today, with information being available at the remotest of outposts ordinarily people refuse to be taken for granted by governments and their functionaries. A decades-old movement for creation of the Telangana state (to be carved out of the southern state of Andhra Pradesh) has gathered strength and is continuing now for months with no solution in sight. The Congress Party which had merged the region with the then newly-created Andhra Pradesh more than half a century ago against the wishes of the locals and against its own better judgement has now been facing the music. With passions running high, life in the state and its capital, Hyderabad, is paralysed with considerable impact on it administration and economy.

The social activist Anna Hazare’s two successive fasts, with unprecedented country-wide support, for enactment of a strong “Janlokpal” (anti-corruption ombudsman) law and later the government’s capitulation are recent history. India Against Corruption (IAC), led by Hazare and his team, are still hitting headlines. It has decided to canvass against Congress candidates at the 2012 state polls if the Parliament reneged from its commitments given during its last session for legislating for a strong “Lokpal” – the reasoning being the Congress leads the coalition at the Centre.

Although the context might be different, IAC’s efforts of swinging elections away from the Congress remind one of the campaigns of The Tea Party in the US during the 2010 Congressional elections. The United Progressive Alliance (UPA) government’s first tenure appeared sedate until, of course, the Prime Minister, Manmohan Singh, insisted on signing the Indo-US Nuclear Deal even at the cost of losing support of one of his important allies – the Left – risking his government’s survival. The government did survive and win the “Confidence vote” only after the “cash-for-votes” scam exploded in the Parliament in 2008. The Congress-led ruling combine’s brazen efforts to soft-pedal investigations into the scandal invited a scorcher from the apex court. And yet, the trial that was hurriedly commenced, based on seemingly skewed investigations, appear to be farcical as none from among the beneficiaries – the Congress-led UPA government – of the scam has so far been hauled up. After IAC’s massive anti-corruption movement the government’s attitude appears somewhat brassy.

UPA I’s survival by dubious means has come to haunt it in its second avatar. All the scams that are currently hogging the headlines are of UPA I-vintage. The biggest of them all – allotment of 2G spectrum – saw a cabinet minister, a member of parliament (both of a southern ally) and a few corporate honchos into the jail, besides embarrassing the Prime Minister who tried to hide behind the nebulous “coalition compulsions”. He was, nonetheless, forced to act by an aggressive Supreme Court. Later, even the Comptroller & Auditor General (CAG) got into the act, putting the finger at the loss of incredible hundreds of thousands of billion rupees.

The relentless media exposes of scams of another few hundred thousand billion rupees during the run up to the Commonwealth Games in 2010 forced the Prime Minister into action to have it investigated by a former CAG. Having shot himself in the foot, he lost credibility. And, it led to a curious crisis of confidence that stalled governance and induced a policy-paralysis even as sycophants of Sonia Gandhi undermined his stature by repeated assertions about eligibility of her son to occupy the highest executive position.

Today, the busiest organisations are the courts, especially the Supreme Court, and investigative agencies like the Central Bureau of Investigation and other police outfits. While virtually every day there are reports of court orders pulling up a public organisation or an individual, every new day brings also the news of a big wig either being put in the coup or refused bail. A large number of politicians of different hues are in Delhi’s infamous Tihar Jail. While the Law Minister, strangely, feared for drop in investments with so many corporate heads in jail, the apex court was taken aback when warned by a government lawyer of destabilisation of the government if it went after high functionaries like the home minister, a case for whose prosecution contributing to the 2-G scam is also currently being heard.

A recent headline spoke of “scams, graft (are) hitting growth”. Indeed, GDP growth has slowed down. Scams and graft could well have been very important reasons. No less important has been the reason of inflation which has been biting the industry and the common man, the very aam aadmi, whom the UPA swore by. The prices have gone through the roof and what hurts the most is the food inflation that has moved beyond 10%. The declining value of the rupee has pushed a few more millions below the poverty line. And yet, the government unmindfully has sought to peg the poverty line at a ridiculous Rs. 32 .00 and Rs. 26.00 per day in urban and rural areas, respectively, fuelling fresh controversy.

None in the government seems to have bothered to enforce checks on the inflated prices of essentials like vegetables and food grains. While the prices of agricultural produce rule high squeezing the common man the farmers commit suicide and, ironically, the cartels and middlemen make their piles. Even, the middle classes have got the wrong end of the stick with repeated hikes in interest rates to combat the prevailing inflation, pushing, inter alia, housing and automobiles out of the reach of many.

Economic growth has, on one hand, been accompanied by growth in numbers of billionaires, enriched ministers and MPs/MLAs, rising numbers of private aircraft, luxury yachts and high-end luxury cars on the roads and, on the other, by huge numbers of discontented and resentful poverty-stricken, malnourished and hungry – by some estimates around 60 million (77% by the reckoning of the late economist Arjun Sengupta) – in rural and urban India. Jobs remaining scarce, petty and other crimes have shown an inordinate rise. Snatchings, thievery, rapine, kidnappings etc. have become common. Worse, while mafias stalk the honest and whistleblowers, murder and rape have registered a sharp rise. Security of life and property has become tenuous.

Polarisation in politics has bred acute intolerance for a contrarian view. Two prominent IAC activists were assaulted – one was beaten up on camera for holding views on Kashmir disagreeable to the extreme right and the other for canvassing votes against the Congress if it did not fulfil its commitment of legislating for a strong Lokpal. While unbridled pursuit of economic growth has made only the rich and the unscrupulous prosperous and happy, it has spread unhappiness and misery among a very large section of the people. At the same time, it has demolished the anchors of Indian society in a mad rush for money; the get-rich-quick syndrome is eating into its moral fibre. Ethical life in India today has been shoved on to, no, not the back seat, but the boot. Reversing this now well-established unholy trend might well be an impossible proposition.

DIWALI 2011 - ADVERTISEMENTS

Healthy Business: Will Medical Tourism Be India’s Next Big Industry?

No Other Choice: Why Medical Tourism Continues to Thrive: President of the United States Barack Obama recently urged Americans to seek medical treatment at domestic health care facilities, rather than traveling overseas. In India, where so-called "medical tourism" (known internationally as the global health care delivery system) is a booming industry, his statements have created quite a stir. In this opinion piece, Ravi Aron, a professor at Johns Hopkins University and a senior fellow at the Mack Center for Technological Innovation at the University of Pennsylvania, argues that people can't take advantage of something that doesn't exist. Until affordable universal care is a reality in the U.S., Aron says, Americans will continue to travel abroad for health care services.

President Barack Obama has asked Americans not go to India and Mexico for medical treatment. There are reasons why these appeals will have no impact on global health care delivery. Patients do not travel to India for health care services because they have a choice and they choose to go to India. They travel to India because they have no choice. They are either uninsured or grossly under insured and they cannot afford the cost of care in the U.S.
If a consumer exercises choice -- among comparable options -- then he or she can be asked to buy American. But the choice that these consumers of global health care services face is between care delivered overseas (Mexico, India or elsewhere) and no care at all. So asking them to stay in the U.S. is pointless. Until affordable universal care is a reality in the U.S. they will continue to travel abroad for health care services. This is not a discretionary spending that they can postpone or redirect.

Characteristics for Success
The globalization of health care services is inevitable in this environment. What are the characteristics needed for the industry to flourish? Look at it at the level of the multi-specialty hospital. The hospital needs to address the patients' sense of risk. If somebody in frail health is going to fly 12 hours to reach a point on the other side of the globe to get a bypass surgery or a hip replacement done in a country that they know very little about and one with a strange culture, they experience anxiety that stems from risk. Most of us weigh the choice of a vacation destination carefully; these people are literally entrusting their lives and well-being to a hospital and doctors that they do not know. So this is a decision that is characterized by a great deal of risk. Hospitals like Bumrungrad in Thailand go out of the way to address this risk. There are four levels at which they do this:

The Four Levels of Addressing Risk
The physical environment: The hospital lobby and the building feel like an excelsior hotel in a first world country. They go out of the way to showcase the sense of order and calm that prevails everywhere. The western patient would instantly feel at home with the Starbucks Café and Wi-Fi-enabled waiting lounges. The hospital and its lobby, lounges and wards gleam in their antiseptic cleanliness.

Process discipline: Bumrungrad hospital is pretty close to what we call a 360-degree automated hospital. From the point the patient has been admitted (from his overseas location) till discharge, all processes are centrally linked to the patient's records and care delivery, and support services are delivered and monitored at the level of each patient. They have extraordinary efficiency in the way they support clinical care with other services -- travel, hospitality (accommodation), transport within the city, billing and post-procedure follow-up.

Excellence in clinical care: Many of their doctors are board certified in the U.S. and in Thailand and Bumrungrad was the first hospital to get the JCI [Joint Commission International] accreditation in the region. On most parameters of medical care -- these statistics are available at the hospital site -- they compare more than favorably with the median hospital in U.S. and the E.U. (They were in the 90th percentile in patient satisfaction scores compared to similar hospitals in the U.S. and Europe).

Strategic use of IT: They use IT both to offer fine-grained information about the hospital, treatments and procedures at the hospital, and physician background to overseas patients, as well as information as a tool for monitoring and delivering clinical outcomes.

In terms of clinical information, they have been able to automate three crucial elements of clinical information flow: (i) Physician-level information from multiple physicians attending on the same patient; (ii) Information from clinical sources pertaining to a patient (tests, labs, nurses and clinical support services); and (iii) patient case history. This, in turn, has allowed them to implement a variety of innovations in care delivery that minimize medical errors, infection rates, etc. It also allows them to monitor patients and their progress in fine-grained detail. (Automating these three kinds of clinical information flows is very critical not only to deliver higher quality of care, but also to create "patient information portals" where the patient can constantly access his or her EHR (electronic health record) after the procedure from his or her country of origin, as well as schedule repeat check-up visits. Automating these three kinds of information flows is one of the reasons that Bumrungrad is referred to by some as the "gold standard" in global health care delivery).

First World Skills in Emerging Regions
So why is all of the above important? These are first-world institutions of skill and service excellence located in developing regions. The developing region economics makes these regions attractive from a cost (price) standpoint to overseas consumers. The first world skills and service excellence makes them attractive from the standpoint of actual care delivered to patients. For the paying patient, it is important to signal that the hospital is an island of calm and order founded on a reliable first world infrastructure and where care delivery is monitored with great precision and discipline. The patient needs to feel that this hospital has been insulated from its environment.

India is not lacking in clinical skill (quality of physicians). Traditionally, Indian hospitals were seen as weak in post-procedural care delivery (sometimes referred to as "post operative care"). But that, too, is changing. Some hospitals are beginning to get their acts together on post-procedural care in terms of significantly lowering medical errors and hospital infections, and improving nurse and support clinician hygiene standards. There is still much that can be done in this regard.

An area that is often overlooked by the Indian care delivery establishment is that of support services: travel, logistical support, accommodation and hospitality, transport within the destination city, billing, etc. Overseas patients are probably comfortable with the quality of Indian physicians; they are more concerned with clinical post-procedural care, support services and the infrastructure.

Medical services in India are where the IT-enabled services and the business process outsourcing (BPO) industries found themselves in the mid 1990s -- the challenge is to convince the customers that these hospitals are islands of excellence that have been insulated from the frailties of India, even as they draw upon its strengths. These services are not branded as "made in India" as much as "made in spite of India."

The Advantages of India
The one advantage the country has is that a doctor in India -- especially a surgeon -- would have acquired in 10 years' time more experience -- both in terms of scale of procedures done and the exposure to varying levels of complexity -- than what a surgeon in the U.S. would get in, say, 30 years of practice. So a doctor with about 15 years experience will probably be unrivalled in the scope and scale of his exposure.

In the well-run hospitals and multi-specialty centers, they have deep reservoirs of capability to treat patients who come in for a procedure with comorbidities [the presence of one or more disorders in addition to a primary ailment]. Not only can they perform the procedure, but they can also deliver related chronic care where necessary (procedure plus care for cardiovascular disease, diabetes, etc). Specialists are readily available to deliver care for comorbidities from a single location.

Almost all these institutions are private hospitals that cater to the needs of India's wealthy, powerful (Anglophone) elites. They are used to delivering services to a demanding clientele. This serves them well with overseas customers. A large number of physicians in the U.S. and the U.K. and in some Gulf countries are of Indian origin. So, overseas patients do not have the problem of entrusting themselves to Indian doctors.

The doctors of Indian origin can also serve as a distribution channel of sorts to hospitals in India. These institutions can tie up with these doctors to deliver some measures of post-procedure diagnostic care and ongoing care in the countries of origin of the patients.

The Low Cost Is a Given
The other advantage is, of course, cost. But there is no need to stress the difference in costs. The patient is usually acutely aware of the difference in the sticker price for care. The multiples range from eight to one to three to one, even after factoring in travel and other non-clinical costs. There is no reason to draw attention to this. It is far better to highlight capabilities and excellence for two reasons. First and less important, is that this will translate into "capabilities and excellence at an affordable cost" in the patient's mind. Second, and more important, the patient is worried about capabilities and support care and the risk of entrusting his life and well-being to a strange system far away from his home. So it is vital to address those concerns rather than emphasize "cheap." The patient is all too aware of the cost difference anyway.

Finally, the use of web-based channels to inform potential patients is key to running an efficient marketing operation. Hospitals should be able to offer information about JCI certification, physicians' experience and qualifications, the depth of their capabilities in performing specific medical procedures (coronary bypass, hip replacements, etc.) and give patients an accurate estimate of the costs.

Bumrungrad's use of electronic channels is a case in point in effective marketing. The hospital has developed a cost simulation where the patient can key in details of his or her condition and the simulation gives a clear estimate of the cost frontier that he or she will face: it gives the patient a distribution of costs that similar patients in the past faced -- including an average, a high percentile and a low percentile number -- allowing the patient to form his or her own estimate of the costs of care. This electronic estimate is based on actual costs of past patients and it is constantly updated from the hospital's database. Bumrungrad is able to do this because every element of the final cost the patient pays is itemized and categorized in the final invoice. This is yet another example of their strategic use of IT to both serve the customer and market their services effectively.

In the past, U.S. President Barack Obama has singled out India for what he sees as the country usurping American jobs and business. In May 2009, he removed some tax incentives for U.S. companies who allegedly preferred to outsource rather than create domestic jobs. "Buffalo before Bangalore" was his rallying call at the time. Now, India is back in his crosshairs. In April 2011, he told a town hall gathering in Virginia that Americans shouldn’t have to go to India or Mexico for “cheap” health care. "I would like you to get it right here in the U.S.," he said.

"It’s a 100% political statement," Gopal Dabade, convener of the All India Drug Action Network, told weekly newsmagazine India Today. Others in India were equally critical and dismissive. But some have taken more serious objection. "Not acceptable," says federal health minister Ghulam Nabi Azad. Affordable health care does not mean our medicine is inferior to any superpower’s. I would like to say our medicines are indigenous, they are superior, and superiority does not come by escalating costs."

The bone of contention is the word "cheap." Obama probably used the term in the sense of less expensive. But Indians have interpreted it as meaning "tawdry and inferior." Analysts don’t expect Obama’s political posturing to make any difference to the flow of U.S. medical tourists into India. But there is a lurking fear, nevertheless, that a nascent sector could be hamstrung at birth.

There Is No Choice
"Patients do not travel to India for health care services because they have a choice and they choose to go to India," says Ravi Aron, professor at the Johns Hopkins Carey Business School and a senior fellow at The Mack Center for Technological Innovation at Wharton. "They travel to India because they have no choice." Adds Rana Mehta, executive director, PricewaterhouseCoopers (PwC) India: "If patients see value in what India has to offer, they will continue to come."

Indians feel aggrieved that they have been singled out. In medical tourism, the country is still a bit player. According to a report by the Delhi-based RNCOS, which specializes in Industry intelligence and creative solutions for contemporary business segments, India’s share in the global medical tourism industry will reach around 3% by the end of 2013. The December 2010 report -- titled "Booming Medical Tourism in India" – says that the industry should generate revenues of around US$3 billion by 2013. "The Indian medical tourism industry is currently in its early growth stage," says RNCOS chief executive Shushmul Maheshwari.

Guess who’s the biggest beneficiary of medical tourism? It’s the U.S. "The largest segment, with 40% of all medical travelers, seeks the world’s most advanced technologies," says a McKinsey & Co paper titled "Mapping the market for medical travel." "These men and women take their search for high-quality medical care global, giving little attention to the proximity of potential destinations or the cost of care. Most such patients travel to the U.S." What worries the Indian industry is that this is not the first attack on Indian medical tourism. In August last year, leading medical journal The Lancet had published an article about a new superbug which it called the New Delhi metallo-beta-lactamase 1 (NDM-1). "The potential of NDM-1 to be a worldwide public health problem is great, and coordinated international surveillance is needed," said the article. Later, a co-author noted that some material had been inserted into the article without his knowledge; the editor of The Lancet had to apologize for naming the bug after New Delhi, and the Indian ministry of health had to weigh in. "The conclusions are loaded with the inference that these resistance genes/organism possibly originated in India and it may not be safe for U.K. patients to opt for surgery in India," said the ministry. "The medical journal's claim is not supported by any scientific data and thus tarnishes the reputation of the country." Rightly or wrongly, the government and many in India’s medical establishment believe that naming the superbug New Delhi was to keep U.K. medical tourists at home. "The superbug certainly garnered a lot of media attention given its name," says Preetha Reddy, managing director of Apollo Hospitals.

It won’t keep medical tourists at home, just as Obama’s appeal is likely to be ignored. "People will always weigh the cost and the benefit," says Reuben Abraham. "If there is a 10% saving and there is a danger of the superbug then chances are that people will not want to take it. But if you are offering an 80% discount, it is a different matter. If India continues to offer high quality health care at one-tenth the cost in the U.S. then these things will not make an impact."

The Next Big Thing
If all this is going to have limited impact, why is India getting so agitated? The answer lies in the potential of medical tourism. It could easily be the next big thing. Unlike business process outsourcing (BPO), which is on the whole very low-tech, health care -- particularly sophisticated procedures -- is very high-tech. India has not been able to set up an adequate health care infrastructure for its own citizens and it doesn’t have the money to do so. Creation of a sophisticated medical tourism structure will have a trickle-down effect.

"India has the highest potential in medical tourism in the world," says Maheshwari of RNCOS. "Factors such as low cost, scale and range of treatments differentiate it from other medical tourism destinations. Moreover, growth in India’s medical tourism market will be a boon for several associated industries, including the hospital industry, the medical equipment industry, and the pharmaceutical industry."His study shows that CAGR (compound annual growth rates) in revenue in 2011-13 will be 26%. In terms of medical tourists, the number would touch 1.3 million by 2013 at a CAGR of 19%. "Medical tourism can be considered one of the rapidly growing industries in the Indian economy on the back of various factors," he says. "However, the industry is at a nascent stage and requires a few years to reach the platform already established by the IT sector." "India has been ranked among the top five destinations for medical tourism," says Rana Kapoor, founder, managing director and CEO of Yes Bank, which has recently done a study on health and wellness tourism in India along with apex chamber of commerce FICCI.

The ranking by Nuwire Investors, an online source for news on alternative investments, puts Panama on top, followed by Brazil, Malaysia and Costa Rica. "India is looking at exponential growth as far as tourism is concerned," continues Kapoor. "Yes Bank forecasts that there will be an increase in domestic tourist movements over the period (2008-2020) by 118% and foreign tourist inflows over the same period will increase by 71.87%. What the potential for medical tourism from within this growth rate of 71.87% will be depends upon government policies, faith of the patients and many other external factors. We truly believe that this sector will play a significant role as a contributor towards the overall tourism growth in India."

"I strongly believe that many developments across the world will put India in a fantastic position," says Devi Shetty, cardiac surgeon and chairman of Narayana Hrudayalaya. "We produce the largest number of doctors, nurses and medical technicians in the world. Also, we have been traditionally linked with western health care because of the British influence on our medical education and the ability to speak English. This is extremely important for developing [global] health care. Our greatest asset is our ability to produce the largest number of technically-skilled individuals. We also have the largest number of USFDA (U.S. Food and Drugs Administration)-approved drug manufacturing units outside the U.S."

Differences over Terminology
Shetty doesn’t like the term medical tourism. "Medical care is something that is very stressful and people consider this under tremendous pressure," he says. "It is an event where people are scared of losing their lives. It may not be appropriate to call it tourism. Tourism is a different business altogether." Adds Mehta of PwC: "The tourism component is really very weak. Most foreign patients come to India for chronic and serious medical treatment and I would call it medical value travel." Aron of Johns Hopkins has yet another view. "The world over it is known as the global health care delivery system," he says. Reddy of Apollo agrees with Mehta. Says she: "At Apollo Hospitals, we prefer to term this business opportunity as ‘medical value travel’ as people travel to our hospitals for serious life threatening health conditions, which essentially need highly skilled doctors and medical infrastructure and not mere minor treatments like cosmetic enhancements, dental work or wellness which can be coupled with holidays, as the term ‘medical tourism’ implies."

The multiplicity of names is accompanied by a wide range of numbers. The confusion was started by the McKinsey study on Mapping the Market mentioned earlier. The May 2008 report said that "medical travel has captured the world’s attention and imagination". But it went on to explain that the McKinsey definition of medical traveler was very different from what many others thought him to be. The first to be knocked off were expats looking for health care in their country of stay. That accounted for 25-30% of the traditional medical tourist pool.

Then was the segment categorized under emergencies. These were ordinary tourists caught up in accidents. That eliminated another 30-35%. McKinsey estimated the remaining at "between 60,000 and 85,000 inpatients a year", much lower than generally accepted numbers. For instance, a 2008 Deloitte Center for Health Solutions report on "Medical Tourism: Consumers in Search of Value" put the number of Americans who had traveled abroad for medical care in 2007 at 750,000. McKinsey excludes "wellness" tourists (acupuncture, spas, yoga, aromatherapy and the like), patients from neighboring countries, and outpatients -- those who don’t need to check into hospital.

The Deloitte report says that India is stepping on the gas; the medical tourism sector is expected to grow 30% annually up to 2015. An update on the report says that the U.S. recession is driving more people out of the country for health care; U.S. outbound medical tourism is projected to increase 35% annually from 2010-2012. "Medical tourism [today] represents the maturation of a cottage industry," the report sums up.

Maheshwari of RNCOS agrees that economic problems are driving more Americans abroad for health care. "Under almost stagnant salary increments, the disposable income and saving considerations of U.S. citizens are still well below the pre-crisis levels," he says. "In this scenario, the low cost treatment and nearly zero waiting time coupled with its proven track record offer convenient procedures for tourist arrivals from various geographical locations including the U.S."

"Over the past few years, the medical tourism story has changed dramatically in India," says a recent Cover Story in weekly business magazine BusinessWorld. (That it made it to the Cover is a reflection of the growing importance of the sector.) "Not because the government has figured out the solution. But purely because of private enterprise -- with a few corporate hospitals, chemists and freelance agents all working in tandem to build a thriving ecosystem that educates, facilitates and ferries medical tourists from across the world. Last year, this ecosystem was responsible for about 600,000 patients travelling to India and spending US$1 billion in getting treated here. (The numbers are industry estimates as the government does not have any official statistics on the subject.) Corporate hospitals such as Apollo, Fortis Hospital and Max as well as business associations estimate that the business is growing by 40% year-on-year." (Obviously, the growth numbers vary depending on who you talk to.)

Other Markets Will Turn to India
"India’s potential is huge," says Mehta of PwC. "Some 80% of foreign patients coming to India are from the neighboring countries and from Iraq, Afghanistan, the former Soviet Union, etc and now increasingly from Africa. But now with India proving itself as a credible provider of value health care, the western population ageing, and health care becoming more difficult there, I expect more people to come from the U.S. and the U.K."

Mehta says that some things went wrong with the earlier planning. "We expected most patients to come from the U.S. and Europe. We expected people to come for cosmetic and regenerative treatment and this is where there is more potential for tourism. But the majority actually came for cardiac treatment, cancer treatment, knee replacement and other serious ailments. Therefore, tourism was not really of importance. We did not get the cost factor right. We thought that typically in India it costs one-tenth of that in the U.S., so we could cost at 5X. But hospitals have not been able to charge very much. At present, with a foreign patient, there is around 20% more earning."

Cost is, of course, being underplayed in the marketing efforts; this is why the word "cheap" rankles. "The patient is usually acutely aware of the difference in the sticker price for care," says Aron. "There is no reason to draw attention to this.”That’s an area where India enjoys an advantage over other countries too. According to the BusinessWorld report, a heart bypass surgery costs US$144,000 in the U.S., US$25,000 in Costa Rice, US$24,000 in Thailand, US$20,000 in Mexico, US$13,500 in Singapore, and US$8,500 in India. "The quality is excellent," says Maheshwari. In India, there is also less waiting time and personalized services.

Becoming an Industry
Medical tourism is also taking shape as an industry, though there are some who feel that it will eventually fall in many buckets. (The recent FICCI-Yes Bank study talks of wellness tourism, health tourism...) "There are over 3,371 hospitals and around 750,000 registered medical practitioners," says Maheshwari.

Shetty says it is easier to get loans these days. "Earlier, it was difficult for us to mobilize huge financial support to create large hospitals. However, things have changed now," he explains. Indian companies are also taking over hospital chains in Asia -- Fortis has gone on a shopping spree, though it’s not been entirely successful -- and setting up front-ends in other countries for marketing purposes. Apollo has facilitation centers in Oman, Nigeria and the U.S. Max is present in Nigeria, Afghanistan, Bangladesh and Nepal. Says Reddy of Apollo: "There are several key players. Apollo Hospitals continues to attract the largest numbers of international patients followed by Max, Fortis and Workhardt."

"Another opportunity that Indian operators are now seeing is that you don’t have to offer these health care services from India," says Abraham of ISB. "For instance you can offer it from say, Cayman Islands or the Bahamas. Ultimately, the innovation is in the process and as long as you can bring the same process innovation, even if the cost goes up a little as compared to offering it from India, it will still be a substantial saving for the patient."

This is one area where China is no threat. Foreigners in China still rush to Hong Kong when they need treatment because they cannot communicate with local doctors.

But what the budding sector will have to contend with is the Indian government. Take one example. With the intention of making things smoother, the government introduced a medical visa (M visa), which was faster and easier to get. In its wisdom, however, it added a peculiar clause -- "Foreigners coming on M visa will be required to get themselves registered mandatorily well within the period of 14 days of arrival with the concerned Foreigners Regional Registration Office." The end result: even patients who have to be carried into India on stretchers are coming on tourist visas. If the government wants medical tourism to be the next big thing, it has to put its house in order.

As for the immediate controversies, Shetty is very clear. "President Obama’s statement or the New Delhi superbug will not affect medical tourism development in India," he says. "First of all, he was not criticizing India. He was just trying to put his house in order."

India's Corporations Race to Train Workers and Avoid Being Left in the Dust

Infosys Technologies, the icon of the Indian IT industry, has one of the largest corporate training establishments in the world, with more than 320 computer science faculty. At its sprawling 335-acre campus in Mysore, Infosys can train more than 13,500 people at once.

"We have invested over $450 million in our training institute," says T.V. Mohandas Pai, director, and head of education and research and human resource development at Infosys."This is probably the largest investment in education in India's history by any entity, be it government or nongovernment, in a single location." Additionally, Pai notes, Infosys spends about $5,000 training every fresh graduate that it recruits. These new recruits undergo 14 to 16 weeks of training before they start their jobs. This year, Infosys will recruit around 18,000 fresh graduates.

Another Indian IT giant, Wipro Technologies, hires around 14,000 fresh graduates a year and takes them through a training program of 12 to 14 weeks. Wipro spends about 1% of its revenue on training these recruits."This is only the running cost," says Pratik Kumar, Wipro's executive vice president of human resources."It does not include our capex cost."

Practically every major IT company in India spends weeks training its fresh recruits. But it isn't something they do by choice. Even those recruits from some of the best engineering colleges are simply not job-ready. Wipro's Kumar points out that if these fresh graduates were"completely deployable in terms of their technical proficiency," they would need in-house training of only a week or 10 days."The huge training infrastructures that companies have set up are a reflection of the inefficiencies of our educational sector," he says.

The National Association of Software and Services Companies (Nasscom) points out that while more than three million students graduate from Indian colleges and the nation produces 500,000 engineers annually, only a very small percentage are directly employable by industry. Says Nasscom vice president Rajdeep Sahrawat:"Only around 25% of technical graduates and 10% to 15% of general graduates are estimated to be suitable for employment in the offshore IT and business process outsourcing industries."

An Industry-Academia Disconnect
The reasons are many. The nation's education sector is highly government-controlled and therefore subject to a multitude of regulations around such matters as curriculum development and pay scales. The quality of faculty and the teaching methodology are largely inadequate. A focus on soft skills -- those personal and interpersonal attributes of everyday interaction -- is lacking. There is a disconnect between industry and academia. The list goes on.

"As a nation we have underinvested in education and employability," says S. Sadagopan, director of the International Institute of Information Technology, in Bangalore. N.R. Narayana Murthy, chairman and chief mentor at Infosys, agrees:"All the stakeholders -- the government, academia, industry and society -- are responsible for the current state of affairs." He adds a somber note:"If we don't take steps to improve the quality of our engineering graduates, we will soon lose out on our ability to compete globally."

The employability issue is not restricted to the IT industry. Even as India celebrates its strong economic growth and touts its demographic strengths, concern is rising over the suitability of its large workforce for the many new jobs that will be available, especially across high-growth industries such as retail, financial services, telecom and aviation.

Sanjeev Duggal, chief executive officer and executive director of Bharti Resources, a subsidiary of Bharti Enterprises, one of India's leading conglomerates, explains:"The employability issue in India is getting impacted by two different [problems]. One, most of the growth is happening in new sectors which require new skills. So not only do fresh recruits need to gain these skills, but even those already employed need to be reskilled; otherwise they will no longer be employable. Second, a lot of growth is happening in smaller towns and cities, and so there is a need to make the training of these skills available locally."

A social factor also comes into play. By and large, the Indian mind-set is oriented toward acquiring a formal university degree and not necessarily acquiring skills for greater employability. Says Rajen Padukone, president of university programs at Manipal University:"The professional skills and vocational programs need to be linked to a university degree, corporate funding and job placements to make them more acceptable to Indian youth."

Entry-Level Skill Gaps
The employability problem persists beyond the graduate level. B. Santhanam, chairman of the Confederation of Indian Industries' national committee on skills and human resources, points out that a 2006 CII study covering 36 sectors estimated that 80 million new jobs could be created in the next 10 years across India, of which 75% will require vocational skills."These 80 million jobs are going to be created if the growth rate that various companies and industries are assuming actually happens," he said."However, in sector after sector we find that there are tremendous knowledge and skill gaps at all levels of jobs. The employability issue does not concern only graduates; it is even more significant at the grassroots entry level, where we need a large amount of vocational skills."

According to the government's 2007-08 economic survey, 68.4% of the population will be of working age -- 15 to 64 -- in 2026, up from 62.9% in 2006. The survey notes that"for actual tapping of the demographic dividend, it is necessary not only to ensure proper health care, but also [to put] a major emphasis on skill development." The survey warns that"if skills are not adequately created, India could well be facing a demographic nightmare."

The primary responsibility clearly rests with the government and academia. However, the growing realization that industry can harness India's demographic dividend only through the availability of the right training and skill sets is driving corporate India to play a larger role in molding the workforce.

Across sectors, companies and industry bodies are not only beefing up their in-house training facilities, but also developing initiatives to make potential employees job-ready even before they enter the organization. These include tie-ups with educational and training institutes, helping them design the curriculum, training faculty in both relevant content and teaching methodologies, offering internships, and setting up their own training schools and finishing institutes.

Wipro, for instance, has identified poor teaching quality as one of the core reasons for the low employability of engineering graduates. To address this, under an initiative called Mission 10x launched in September 2007, the company has developed a set of teaching techniques to enable faculty members to help students take in higher levels of understanding of classroom subjects while developing key behavioral skills as well.

Under Mission 10x, Wipro plans to train more than 10,000 faculty members in 1,500 engineering colleges over the next three years. The training, for which Wipro bears the entire cost, is spread over five days. Says Azim Premji, chairman and managing director of Wipro:"The quality of education being imparted requires fundamental change. We need to bring about a systemic change in the current teaching-learning paradigm in engineering education."

Training the Faculty
Nasscom's key focus, too, is on upgrading faculty. It estimates that 12,000 to 14,000 faculty members need to be trained in the next three years to increase the employability of students recruited by the IT industry. The group is putting together a plan to work with the government and industry to address the issue, Nasscom's Sahrawat says."It is a very manageable and doable proposition. What it requires is willpower and program management."

Meanwhile, in a move to expand the pool of industry-ready resources for the banking and insurance sector, which is expected to create a million jobs a year for the next five years, leading players are offering industry-specific courses. ICICI Bank, India's largest private-sector bank, for instance, has joined with Manipal University to create the ICICI Manipal Academy of Banking and Insurance to offer a one-year residential diploma program to graduates who are selected through an entrance test. The bank and university have jointly designed the course content.

On completion of this program, which is expected to result in"first-day, first-hour productivity," the candidates will be absorbed in a managerial position in ICICI Bank, which is picking up the entire training tab of Rs 2.5 lakh ($5,425) per student."To fulfill India's global aspirations and sustain the growth trajectory, it is imperative that industry invests in preparing industry-ready human talent," K.V. Kamath, managing director and chief executive officer of ICICI Bank, said in a news release.

R. Bhaskaran, chief executive officer of the Indian Institute of Banking and Finance (IIBF), points out that the need for industry-ready professionals is becoming increasingly important not only because of the sheer numbers required but also because of changes in the banking industry in recent years.

"There has been a paradigm shift within the banking industry," he said."We used to wait for customers to come to us, but now we have to go out and sell. This has also resulted in many specializations within the bank. While in the past anyone could manage any function, we now need specialists." In keeping with this requirement, over the past few years IIBF has introduced diploma courses in such areas as treasury, international banking and microfinance to both fresh graduates and banking professionals looking to enhance their employability.

Modern Retail's Skill Sets
Retail is yet another area undergoing rapid transformation. Organized retail accounts for only 3% of India's retail sector, but that is expected to increase to 20% by 2010. This is expected to result in demand for 2.2 million new jobs. Retail majors including Reliance Retail, the Future Group, Bharti Retail and Shopper's Stop, as well as the Retailers Association of India, have tied up with various universities and training schools to provide course content and internships to students.

Says Biju Kurien, president and chief executive, lifestyle, for Reliance Retail:"Traditionally, retail in India has been in the unorganized sector comprised largely of small owner-driven stores. Modern retail requires very different skill sets, both because of the different nature and size of operations and increasing customer expectations." Kurien says Reliance is likely to employ around a million people for its retail operations over the next five years and is looking to set up its own university for retail education.

Meanwhile, the Bharti Group has created its own training and development company called Bharti Resources, which has set up a Bharti academy of retail in conjunction with the group's retail arm and is creating an academy for insurance in alliance with the group's insurance business. Bharti Resources has also set up 60 learning centers across the country to offer courses in insurance, telecom and retail. The target is to take this number to 100 by the end of this financial year and at least 1,000 in the next three years. Says Duggal of Bharti Resources:"With a lot of growth happening in smaller towns and cities, it is very important to have a huge distribution reach of the training of these skills."

Along with training where people are located, another challenge is the need for short-duration vocational courses for those who have not completed their formal education. To address the issue on a wide scale, CII is helping the government roll out a"modular employable skills" program. It is putting together the curriculum and identifying a set of assessors and the institutes that can carry out this training for different sectors."Our target at CII is to train at least 50,000 people through this program in the current year," CII's Santhanam says.

Upgrading the ITIs
CII is also working closely with the government and large companies in a public-private partnership model to upgrade the government-owned Industrial Training Institutes (ITIs) and align them more closely with the needs of industry. Companies that have adopted ITIs include Bosch, Hero Honda, Ashok Leyland, Larsen & Toubro, and Bharat Heavy Electricals Ltd.

Another key initiative of CII has been to help universities to understand the importance of soft skills and to integrate related courses into the university curriculum. While Madras University has made a soft skills course mandatory for all undergraduate and postgraduate students, other universities in the state of Tamil Nadu have included such coursework as part of their choice-based credit system. CII, which developed the curriculum and is also training the trainers for this course, is now looking at extending soft skills training to universities across other states. Companies working actively on this initiative include Tata Consultancy Services, Cognizant Technologies and Satyam Computer Services.

Says CII's Santhanam:"Never have I seen such a confluence of efforts of private companies, industry bodies, government and academia on the one common issue of skill development. If we can grasp this opportunity fully, we can set in motion something that can completely alter the employability landscape of the country."

Not everyone, however, is so optimistic. Manish Sabharwal, chairman of TeamLease Services, India's largest human resource services provider, strikes a note of caution. Skill development, he says, is only one part of the solution."There are three problems in the current Indian system: matching supply and demand, repairing supply for demand, and preparing supply for demand," he says."What we are all focusing on right now in terms of employability with skill development is only the repair part. This is a low-hanging fruit. But this repair pipeline will run dry if the prepare pipeline, by way of education reforms, is not fixed. And that is something that the government and academia need to work on."