I shared a message with my email subscribers. It was about my “Magic Number“.

My friend Shel Horowitz tweeted me some feedback about it. One point he made was the possible lack of confidence inspired by my mentioning (to a primarily U.S. audience) that we’d only raised around $135,000 since starting this effort.

Curious, I Googled the topic – and found this recent article in TIME.

“With 3.3 million registered NGOs, India’s nonprofit sector raises between $8 billion and $16 billion in funding every year.”

Hmm… that was interesting data. And then, I came to this startling statement.

“…of $2.15 billion in foreign aid recieved, around $680 million was used for organizational expenses.”

That’s almost 31% of the funds raised being spent on administrivia. (For comparison, my Foundation averages THREE percent!)

And that led me to think about constraints and hurdles I’ve faced in fund raising adventures over 7 years, which might make for an interesting blog post. Here it comes.

There have been many limitations in my efforts to raise money for helping children from under-privileged families receive expensive treatment for congenital heart defects.

The biggest among these were:

Credibility – Ten years ago, with no track record to point at, I had to rely on the trust of people (who had never even met me!) to support my fledgling efforts. Fortunately, enough of them cared to help make it happen… and bring us to this point where I can point at many smiling faces for proof.

Time – Until recently when I chose to make this project a full-time activity, I was juggling duties as Assistant Professor at a busy University hospital with managing a thriving online information business, leaving me severely hard-pressed for time to handle everything that needed attention.

Laws – Constantly changing and getting ever more restrictive (for legitimate reasons, to prevent money-laundering and terror funding), these made it increasingly harder to raise and transfer foreign funds into India.

Patient factors – Having a waiting list without adequate funding was impractical. So whenever funds became available, we went through a sequence of activities to find and bring in kids to undergo surgery. The lack of a structured process made this time-consuming and uncertain.

Transparency – Without popular 3rd party validation agencies with sufficient clout to have impact, getting ‘certified’ as a valid NGO in India was impossible. The few smaller ones had exceedingly complex application steps which would require a full-time staff member to deal with requirements. (One had an 86-page form just to apply for registration!)

Amid all this, I gamely battled on. Patched together a system that worked, even if not very efficiently, to raise funds and carry out 70 heart operations.

But suddenly, policy changes at our primary payment processor jerked the rug out from under us in July. Suddenly, the fragile edifice cracked and looked ready to collapse. It took a determined and focused phase of activity to cobble it back together – and a more permanent solution is being worked on as we speak.

From one perspective, seven years of action without leading to a rock-solid system to overcome all these hurdles seems to indicate a slacking off and waste of time, or misguided effort and lack of direction. And regardless of how harsh you or anyone else may judge me on this, I suspect it won’t be 10% as hard as I’ve been on myself.

But compared against the average Indian NGO which is often better staffed, organized and managed than my smaller Dr.Mani Children Heart Foundation, our performance (even if not shining or stellar) is fair. As this “Civil Society” article says,

“Very few of India’s NGOs are very big: there are perhaps just 200 with more than Rs 25 crores (US$5 million) each to spend in a year. Around 70 per cent are the very small organizations, some with as little as Rs 4 or 5 lakhs (US$10,000) in a year. It is these small outfits which reach out to communities, work at the grassroots and represent the true spirit of an active and vibrant voluntary effort.”

Are there problems? Of course. There is corruption and mishandling of funds. Some Indian charities are structured so that they are merely tax saving entities rather than delivering value to their beneficiaries. And overheads can be steep, as the 31% average figure indicates.

But that’s the tiny minority of “rotten apples” you’ll find in just about any barrel you choose to poke around in. As “Civil Society” comments,

“These are valid concerns, but not as widespread as it has become fashionable to imagine. Essentially people who take up causes really care and they are as honest as the system allows them to be.”

And so the battle continues. Evolving and adapting to the uniqueness of India’s non-profit environment is an interesting, sometimes frustrating, and never uneventful experience, one where creativity and innovation are often better and more rewarding weapons against uncertainty than credentialing and striving to comply with norms.

That’s why I try different and unconventional approaches. Like running this special “Business Booster Sale” which promises to give business owners incredible value for making a contribution to charity.

Far better than just going to them, hat in hand, with an appeal seeking a donation, don’t you think? Take a look at this offer (you’ll be blown away by how much value you’ll get) and tell your friends about it too. But hurry – because it ends on December 31st, 2010.

And you can also be in my “Magic Forty” – get more details here

12 years ago, at Great Ormond Street Hospital in London where I went for a one-year fellowship in pediatric heart surgery, I was often asked “Do you know Dr.Cherian?”

This question always surprised me. After all, there are over 1,000 heart surgeons in my country, and I hadn’t even mentioned that I was from Chennai. That’s how well known this pioneer of Indian pediatric cardio-thoracic surgery was around the world.

For years, we young, hopeful students of heart surgery had been aware of the hallowed names of the nation’s top professionals. And one that stood out was K.M.Cherian. There was much said about him – not all of it complimentary, but all of it legendary!

His remarkable technical skills. His amazing drive and energy. His genuis at building teams and drawing the best from them.

But looking back years later, what strikes me as Prof.Cherian’s biggest impact is that he branded Indian cardiothoracic surgery globally – as a high quality, mission-driven and compassionate specialty that’s no less than anywhere else in the world.

Today, if Chennai is considered the heart surgery capital of the fastest developing democracy in the world, then a large share of that branding effort goes to Dr.Cherian. My first personal experience of his impact was at a World Congress he organized in 1995 – at which, as a resident in training, I rubbed shoulders with some of the biggest names in the global cardiac surgical fraternity.

Fifteen years later, the 20th World Congress of Cardio-thoracic Surgery that’s now underway in Chennai is another jewel in his glittering crown. Professionals from 40+ countries converge on a city thousands of miles away because of one man’s effort at branding a specialty in their minds – as the very best.

And as surgeons from Uganda and Taiwan, Tanzania and Bangladesh, all narrate the tale of how they established cardiac units starting from scratch in their respective nations, thanks to the know-how, support and encouragement they received while they trained with Dr.Cherian in India, it opened my eyes to another new dimension of the pioneer surgeon’s impact on our specialty globally.

The ripple that Dr.K.M.Cherian has set off in his lifetime will only grow bigger and touch many more thousands of lives, as those empowered and inspired by his dream, vision and actions carry the baton and build upon a solid foundation.

Hopefully, a lot of what we (as a cardiac surgical community in India) say and do in the future will reinforce that brand of “Heart Surgery India” in a way that remains a tribute to the man who helped put India on the world map in this area.

I know my own actions will be guided by that goal… and I tip my hat to a hero and role model!

I have many heroes in my chosen field of heart surgery. Like Dr.Denton Cooley, Dr.K.M.Cherian, Prof.Marc de Leval and Dr.William Novick. Yesterday, I met another one.

Until I attended his lecture at the 20th World Congress of Cardio Thoracic Surgery, I had never heard of Russell Lee. After it, I won’t forget him!

Quiet, unassuming and brilliantly effective, Russell has spent a lifetime co-ordinating surgical missions to 23 different countries, helping save the lives of little children.

His work started in 1986. Over TWENTY FOUR years, it has touched over 3,000 little lives! And in his presentation, he shared the story of how it all began.

One slide showed a little 5 year old girl in a tiny bathtub. It was Russell’s daughter, now 30 years old. And he told us a story.

On a field trip to Tonga in the 1980s, his team had been evaluating patients with heart disease. The poverty was so severe, none of the hundreds thronging the clinic had a hope of being able to afford treatment in another country. And heart surgery facilities in Tonga were unavailable.

Among the patients, there was one woman who shared the same birthday as Russell’s wife. And she had a daughter who was almost exactly the same age as his. He says: “With a shock, I realized that six months from now, this lady may not be around for her child.”

That realization disturbed him. It sparked off a dream and a vision. One that he sustained for 24 years. And helped him reach out to save the lives of thousands of unfortunate kids and young people with heart disease.

Russell spoke of the importance of having a vision and a team. He touched upon passion, patience and persistence as virtues for anyone engaged in such a calling.

The most poignant moment of his brief lecture was when he pointed out that “Unfortunately, we can’t save everyone”. I explored this further with him afterwards, as it’s a tough choice I’m forced to deal with in patient selection, too.

“If one child has to stay in ICU for 3 days, that’s 3 other children who just lost a chance” he explained. It was a powerful paradigm – and one any social worker facing resource constraints will identify with, and appreciate better.

I told him how inspirational I found the figure of 3,000 operations in 24 years – especially as it had taken me nearly 8 years to fund 70 heart operations through my Foundation.

Russell explained how it takes time to build momentum. His first mission performed 5 operations. The latest one did 56 operations over an 8 day period!

I left the auditorium feeling energized and inspired. And on the long drive back home, I couldn’t help but wonder… If God were to take human form, maybe he’d look like Russell Lee. I’m sure his little heart kids would agree!

Someone asked me once what it is like to hold the heart of a child in my hand.

“It must be so tiny,” he said. “How can you see to put the stitches in?”

I thought for a moment.

“It is tiny,” I agreed. “It is the size of a hummingbird.”

“And sometimes that is what I think of when I listen to some little hearts. The frantic beating, the flutter of a heart desperate to fly freely inside a child’s chest.

“I think, ‘There is a hummingbird in this child’s chest. A ruby-throated hummingbird, desperate to live, desperate for the nectar of life.’

“And I imagine that I must approach it carefully, and hold it gently, but firmly.

“When I hold it I can feel the warmth through my gloved hand.

“I could think about how I hold the future of the child’s life in that hand. I could think about how I hold the laughter, the joy, the tears, the future of that child in my hand.

“But it would overwhelm me to think about all that they could be and I could not do my job. So I ask my assistant to think about those things for me.”

“Who is your assistant?” he asked.

“Why you of course!” I smiled.

“Me?”

“Yes, let me show you. Empty your pockets into your hand.”

“Everything?”

“Yes, everything.”

I watched as he did as I asked. Then I began to remove the items one by one.

I took away his keys. I took away a pack of gum, a breath mint, some loose change. I took away a parking stub and a small charm until the only thing left in his hand was his wallet.

Then I closed his fingers over it gently until he was holding it securely.

“You are my assistant. In your hand you hold the life, the laughter, the love, the future of a child. Her heart is only a little smaller than your wallet.

“I have taken away all the things in your hand that are your life – the keys to your car, the entertainment of an evening, the sweetness of candies. All that is left is what matters – a donation.

“You are the one who truly holds her heart in your hand. You are the one who can afford to think about what her life could be like. Will you do that?”

He looked at me with tears in his eyes and asked, “And then what will you think about?”

“I will think about hummingbirds. I will think about how to slow the tiny flutters and how to stitch the holes. And I will think about what I can do to save her life.

“I can… because you hold the most important part in your hand.

You hold the possibility of life.”

Make a difference. Heal a child’s heart. Click here to see how.

(With deep gratitude to Becky Blanton – for putting into words the feelings that were trapped in my heart!)

Imagine…

A tiny little two year old girl in my out-patient
clinic. Bright eyes. Long, curving eyebrows. Jet
black, curly hair.

But her breathing is labored. Her chest heaves
and falls with every heart beat.

Her pinched, anxious face is intense with the effort
it takes to suck air into her starving lungs.

I place my stethoscope over her heart… and can
hear the loud roar of turbulent blood flowing
across the hole in her heart.

It’s pushing twice as much blood into her small
lungs, flooding them with fluid, choking her.

She needs treatment. An operation to fix the hole.

Her family doesn’t have the money for it.

. . .

Imagine…

A large, brightly lit hall in a hotel halfway
across the world. Smartly dressed men. Beautiful
women. All power-networking in a business climate.

There’s energy crackling in the air. Here are some
excited entrepreneurs, gathered to learn how to
boost their business success, and generate more
wealth.

It’s the NAMS workshop.

And David Perdew walks on stage. He makes a short
announcement.

Its impact will reach out to a little girl in India
- and save her life!

. . .

Imagine…

A smiling little face, clutching a stuffed toy and
hiding shyly behind her mother’s saree as she peers
at me from her hospital bed.

The relieved smiles on her parent’s tired faces, as
they look lovingly upon the relaxed, healthy face of
their little girl.

Priyadarshini is no longer fighting to survive.

She had her surgery. Her VSD has been closed. The
money for her treatment became available.

Because People Like You Cared Enough To
Make a Difference!

Attendees at NAMS donated $1,300 in a day – to fund
her treatment.

While they learned to build a business, they also
saved a little life.

. . .

Imagine…

The feeling of deep satisfaction and joy that comes
from being able to do this.

The sense of purpose and wonderment when you become
part of a child’s future.

The excitement and energy that is a natural result of
being involved in a worthwhile cause.

I Want That Feeling For YOU

That’s why I’m inviting you to join NAMS4Kids – on
August 20th.

You can be a part of a massive giveaway event which
will raise AT LEAST $10,000 to fund heart surgery
for kids.

But first, I’d like you to listen to a rare interview
I did with Roger Carr about this event. Here’s the
link:

Listen to the interview

Then, decide if you want to be a part of NAMS4Kids.
I hope you will want to go here, and take the next
step:

Learn more about NAMS4Kids – click here

Thank you from my heart.

It was around 8:00 p.m. I was working on a blog post, when my wife read about it on a news website.

“A.R.Rahman’s daughter had surgery – for a congenital heart defect.”

The familiar cold feeling gripped my heart. Fifteen years of fighting this deadly scourge hasn’t yet made me immune against it. I clicked through to Google News and Twitter to learn more.

Thankfully, A.R.Rahman tweeted that his little girl was well on the path to recovery from heart surgery. I breathed a prayer of thanks. At the same time, I couldn’t help but recall some sad facts about congenital heart disease (CHD).

* 7 in 1,000 children are born with some form of heart birth defect
* Many of them need treatment, often surgery, very early in life
* Surgery is very expensive – and 95% of Indian families cannot afford it
* Treated on time, children with CHD have near-normal lives
* Left untreated, they succumb to complications that cripple, or kill

And the statistics, though improving, are still dismal.

• 2,500 children with congenital heart disease die every month

• Almost 1 million kids with CHD are waiting for treatment in India
• 40,000+ children need surgery for CHD in my state of Tamilnadu alone
• Barely 2,000 operations for congenital heart defects are performed in my state each year
• Facilities and expertise to treat complex CHD are very limited
• Research into causes and prevention of CHD is practically non-existent in India

For 15 years now, I have invested time and effort into spreading awareness of congenital heart defects.

And by harnessing the power and reach of the Internet, aided by the support of thousands of people across the world, my message has touched an estimated 3 million people over this time.

With the funds raised through various efforts, my non-profit Dr.Mani Children Heart Foundation has sponsored heart surgery for 70 children from under-privileged families.

And now, at one stroke, Mr.Rahman’s unfortunate encounter with this dreaded health condition will make many times more people aware of the threat CHD poses to millions of our children!

Just as when Sylvester ‘Rocky’ Stallone’s daughter underwent surgery for a ventricular septal defect. That stressful experience led to the Hollywood star making a big contribution to Dr.Hillel Laks’ unit in San Francisco – but more important, it brought an awareness about congenital heart defects to millions of the star’s fans.

Many people think heart disease is something only adults get. And when they become aware of the problem, there is an intense willingness to join in the fight against CHD, and a keen desire to reach out with a helping hand to assist the suffering millions.

I empathize deeply with what A.R.Rahman, the ‘Mozart of Chennai’ is going through, as his little girl recuperates from the ravages of surgery on her ailing heart.

But at the same time, seen from another perspective, this accident of nature may end up touching the lives of millions of others less fortunate than Raheema – and brightening their futures.

Awareness about congenital heart disease may lead to interest in helping those affected by it. And with a large, concerted effort directed at the problem, it is possible to make a significant impact.

I imagine that Mr.Rahman’s feelings aren’t much different than those of my patient’s dad I described here.

Because behind the thin veneer of civilized sophistication that we wear, we are all insecure, frail, vulnerable beings.

And behind the facade of fame and glory, power and wealth, we are uncomfortably aware that the thin, tenuous thread of our physical existence hinges on vagaries of a cruel, uncertain fate.

A fate that is even more poignant and vivid in the lives of those touched by the harsh and unkind spectre of congenital heart disease.

- – -

Links for more information about congenital heart defects:

• Spread Congenital heart defects awareness

• Join a 47 Hearts Group
• The Children Heart Information Network

In today’s newspaper, I read an interview (”All Lives Have Equal Value“) with Melinda Gates, co-founder of The Gates Foundation. She said “Bill and I care about keeping all kids alive.”

In medical school, we study pediatrics as a subject. One surefire question that was asked in oral examinations related to “Infant Mortality Rate” (IMR).

How is it defined? What is the current figure in India? In Tamilnadu (our home state)? What was the target IMR for the next five-year plan?

Infant Mortality Rate is the number of infant deaths per 1,000 live births in the population. By demographic definition, an infant is a child below 1 year of age. A sub-group within it is the ‘neonate’, who is under 28 days old.

IMR is a metric. An important one. Because it is an index of the overall healthcare infrastructure of a country, state or community.

To me, IMR has meant different things at various stages of my medical career.

In 1987, as a student appearing for my exams, it was a number to memorize and recall when needed.

In 1989, it was a figure to remember, to avoid being shamed in a conference hall when called upon to quote it by the Director of our institute.

In 1996, when I was once again involved in treating children (as a pediatric heart surgeon), it was a magical representation of the impact a simple political and administrative shift could make on a broad population.

In the interim, the impact of a Government backed program had kicked in. The free midday meal scheme for school kids was launched in 1982 by then Tamilnadu chief minister, M.G.Ramachandran – at a cost of around $40 million to the exchequer.

And seven years later, once familiar sights of a pot-bellied toddler with kwashiorkor, or a wasted, thin school child hit by marasmus, were now rarities in the same institution where I had been a medical student… barely 7 years earlier!

In 2001, the same metric was a symbol to my aching heart of just how far we had to go in delivering optimal healthcare to our children. I had spent two years (in U.K. and Australia) training in infant and neonatal heart surgery, and saw infant death rates of 7-9/1,000 in those countries become rallying calls for radical improvement!

In 2010, a full twenty years since I graduated from medical school, the same number that was a factoid to be reproduced in an oral examination, had become the central focus of my daily professional work. Treating congenital heart defects, which now accounted for a large share of infant deaths, brought about this change.

By now, the IMR had dropped from a staggering 126/1,000 live births (in 1987) to just 31.

That means a child born in my home state has a FOUR TIMES better shot at celebrating his or her first birthday than just 20 years ago!

What a miracle in healthcare!

And what a sobering realization that it’s more a policy decision to improve nutrition and provide universal vaccination to the masses or clean drinking water that can claim the lion’s share of credit for this amazing development!

Most infant deaths are the result of infectious/communicable diseases, nutritional deficiences and congenital defects.

And now, with other causes (infections and nutritional) coming under control, congenital defects are responsible for a larger fraction of IMR, and medical science has an important role to play. My role as pediatric heart surgeon is key in this scenario.

Today, IMR is a number that’s once again relevant in a major way to my everyday life as a doctor, a surgeon, a healthcare advocate.

And a dreamer!

Infant Mortality Rate has evolved to become a more DIRECT metric that reports on how effective (or not) our efforts are in treating congenital heart defects.

Yes, it’s just a number. But a pretty important one!

Now this is WIERD! Real weird!

I drafted a post about a certain drug – and couldn’t post it here on my blog despite trying many different ‘tricks’ (including turning off my spam filters!)

So, I put it on a separate web page – you can read it here!

What’s inexplicable to me is how I find HUNDREDS of spam comments showing up for moderation that include the offending word – yet I can’t post a note referring to it on my own blog!

Censorship gone wild, huh?

Seth Godin pre-launched his new book, LINCHPIN – in style. In the process he helped raise $100,000 for the ACUMEN fund.

I’m working on my 2010 budget for the Dr.Mani Children Heart Foundation. We are likely to spend $45,000 to sponsor more heart operations (between 80 and 110).

Viewing these two facts together brought something into sharp focus. I’ve hit my “glass ceiling” in terms of scaling the CHD project… but can try something new which just might work!

The Foundation gets funds from 2 primary sources – a share of my business profits, and from donations. To scale either of these will mean an extra investment of my time and effort into my business and/or fundraising activities – and there’s a finite limit on those resources… especially when carrying out the operations will itself take up an increasing proportion of them.

But what if I had ‘evangelists’ helping out?

Seth Godin didn’t raise money for Acumen from just one casual mention on his blog or email list. No. His tribe has heard him talk about it for YEARS.

And so when Seth asks us to support Acumen, thousands of people willingly shell out $25 or more – because we know how that will help entrepreneurs around the world!

That’s the impact that comes from a story-teller constantly sharing a compelling tale – with an attentive audience.

So, the answer to that question leads to another…

Should I also seek celebrity evangelists?

Until now, my efforts to spread awareness about congenital heart defects have been assisted by thousands of people. And some of them have helped consistently over a long time.

One thing is clear. The impact over time from an evangelist (with even a small audience) is greater than a casual mention or introduction from an incidental supporter with celebrity status.

Of course, a really passionate and involved celebrity helping raise funds would be fantastic… and that’s where YOU come in.

Because YOU are a celebrity!

Ok, maybe not a MEGA-celeb, but most certainly a MINI-celebrity – or even a MICRO version of one.

You have connections and a network. You have access to tools (online and off) to share a story with them. You have the potential to set off a ripple that can grow and spread far and wide.

The only question is whether you are a passionate, interested supporter who wants to make a difference in a child’s life? If yes, I want to hear from you – and work together with you in 2010 and beyond.

And even if you are not, there’s a way you can help – if you have a few moments to spare and will give the problem some thought.

• Tell me what you think I should be doing next?
• What steps can (should?) I take to keep momentum building?
• Who can I contact pro-actively about helping with this?
• How should I approach them – and why?

I’ll keep quiet now. And listen to what YOU have to say.

I’ll consider every suggestion. Your voice, view and opinion matters. And it just might end up saving a child’s life.

Please use the comments box below. Thank you.

Image credit sxc.hu

In a few days, an event for which I’ve planned and prepared for months will take place. On August 25th, 2009 I will officially ‘launch’ my first ever print book,

“Think, Write & Retire – How To Turn Words Into Wealth, Easily!“

On the threshold of this special moment, there are mixed feelings. On one hand, there is the thrill, excitement and anticipation of what’s to come. On the other, is uncertainty, hesitation and fear.

As I lay awake in the still, quiet darkness late at night, fingers throbbing from dozens of emails sent to partners, eyes burning from staring at a computer screen all day, brain fuzzy from long hours of focused activity, a thousand questions stumble over each other in my mind.

Some of them are technical…

* Have I finished all the tasks listed out for the launch?
* Did I follow all the 38 steps in Mark Joyner’s “Bestseller Blueprint”
* Are all the links working on the sales page?
* Does Amazon.com have enough copies in stock to go?

… and others more abstract.

* Is everyone on my ‘partner list’ aware of the event?
* Are all the promotional pieces in place and ready?
* How am I going to monitor progress during the launch?
* Did I choose the right day and date to do this?

But the more troublesome ones go like this:

* Do I have a big enough ‘author platform’ to launch a bestseller?

* Do enough people on my list care about ‘heart kids‘ to buy a copy?

* Have I done all that’s possible to make this launch a success?

* What if I fall flat on my face and no one (or very few) buy?

* Could I have done something more worthwhile with the same time?

Tough questions. Ones only time will help answer. And where the answers may well be painful, or revelational.

And YOU will be a part of those answers. You, and what you do on August 25th.

Ostensibly, the goal is to sell 1,000 copies on launch day. I’ll be happy with 300, disappointed with 100, and disgusted if we sold fewer.

But no matter what happens, it will have been an interesting experience. One to learn from – and grow.

My mind clung on to that thought as I drifted away into a dreamless slumber.