Scaling up in “The Many Indias”


‘India is merely a geographical expression. It is no more a single country than the equator’- Winston Churchill

Had I read this quote five months ago, I would have not understood what it meant. But after living, traveling and working in India for exactly that long, I can say that Winston Churchill was exactly right. In India, like in any other large country as the US or Mexico, I expected to find some regional differences in people’s tastes for food or music, their accent, dress code, etc. In my mind, these differences give countries their character and do not have major consequences for business other than the opportunity to bring in some variety to the portfolio of products or services. In India, however, regional differences go FAR beyond the ones I just described. For this reason many authors to talk not about one country but “the many Indias”.

For an enterprise trying to do business across the Indian territory, it is critical to be aware of all the nuances of “the many Indias”. Allow me to illustrate what I mean by this using AyurVAID: Hospitals, the organization I am working in, as an example.

AyurVAID: Hospitals is a local business with the mission of providing high quality, affordable Ayurveda (India’s traditional system of medicine) treatment for chronic illnesses across all socio-economic segments and across India (and some day abroad). In line with this vision, AyurVAID: Hospitals opened six small to medium sized hospitals in three neighboring states: two hospitals in Kerala, three in Karnataka and one in Maharastra. The hospitals are located in urban areas and three of them in the big cities of Mumbai and Bangalore.
At first glance AyurVAID: Hospitals’ strategy of expansion seems very straightforward, but in practice things are let’s say a bit more….complicated. Here is how:

Language– At each location, all sign boards and advertising material have to be translated into at least 2 different languages (English + local language) and 4 in the case of Mumbai (high immigrant population). Our doctors need to speak 2 to 3 languages to communicate with patients, English to communicate with the management and international partners, and Malayalam, the language of Kerala, to speak with the staff.

Human resources– The roots of the Ayurveda system of medicine can be traced back to the state of Kerala. Although today Ayurvedic Medical Colleges train doctors across the country, training institutions for therapists are still highly concentrated in Kerala. Hence, hiring locally becomes a difficult task and most of the therapists have to be relocated from Kerala to other states. Then again, most people in Kerala have a strong affinity for their state and prefer not to leave it.
Systems of medicine– Whereas in other parts of the world, Allopathic or “Western Medicine” is the norm, in India, patients have many other well established options to consider like Ayurveda, Homeopathy, Allopathy and Unani. In competing with these different options, public awareness about Ayurveda is a big challenge. If we take allopathic medicine as an example, most people today know what to expect when they go to a doctor, to a hospital or understand if someone says they need a “dialysis”. On the other hand, Ayurveda means a variety of things to different people, particularly as the distance from Kerala increases. To test this last point, I decided to interview people in the streets and hotels of Kerala (to get some out of state opinions) and asked them one simple question….Observe.

All of these factors make the business at AyurVAID: Hospitals challenging and exciting! One success factor as we continue to grow and do business in “the many Indias” will be to strike the right balance between standardization and customization of our services.

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5 Responses to “Scaling up in “The Many Indias””

  1. Rob Says:

    Nicole –

    Quick question – what is the first word YOU thought of when you first heard about Ayurveda and AyurVAID: Hospitals?

    (I’m talking about back last summer before you started the Fellowship)

    Just curious! Great post and video, btw.

    — Rob

  2. balakrishnan mechakkatt Says:

    First name which comes to a Keralite in connection with Ayurveda is as follows:-

    1.Traetment of ailments based on VEDIC periods.’AYUR’ means life.

    2.Unlike other treatment forms ‘ayurveda’ doesnot have allergy or side effects.
    3.The medicine is made from herbs and natural plants flowers and fruits.

    4.The methodology followed is simple, our mater nature has all the ingredients to cure 100 percent ailments,british out of lack of knowledge behind the vedic science,simply took it as a tribal form.which is not so.
    5.though 75 percent of the incredients are lost and no more known to the present generation ,you still have the scriptures to back for preperation og medicine and method of treatment which differs from man to man,fortunately off late Kerala Govt encouraged studies in ayurveda and is now most widely used in Kerala more than the vedic period perhaps or some where near to that.

  3. balakrishnan Says:

    get back to me for details about AYURVEDA.[Treatment of ailments with the help of Vedic Science,ancient,using only natural herbs and no chemicals used .

  4. Nicole Says:

    Hello Balakrishnan,

    Thank you for the additional details you supplied about Ayurveda. Most of them are correct.

    There is only one to which I would like to add and that is point 2: Ayurveda has no side effects. As the doctors at our hospital have explained to me, Ayurvedic medicines, like any food or substance we intake, have a side effect on our body which is not necessarily a bad one. However, what this means is that we should not take Ayurvedic medicines without consulting a doctor because a medicine that may be beneficial for a person may not be as beneficial to someone else.

    This is based on the Ayurvedic concept that the human body is composed of three fundamental constructs called Doshas (3) that are predominant in different proportions in each person. Through food and lifestyle we may bring the Doshas out of balance.

  5. rickroux Says:

    I wanted to share an incredible source on Ayurveda, the ancient medical science of Natural Healing. This site has free educational content, videos, articles, and learning tools. I was amazed to see that this ayurvedic school has online videos of their classes for FREE! … to visit their website click on or copy:


    Rick Roux

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