Meet one of the visionary entrepreneurs transforming eye care in Mexico

Host stories

Sarah O'Reilly

05 June 2019

Javier Okhuysen and his partner Carlos Orellana are on a mission to eliminate needless blindness in Mexico. Their social enterprise, salauno, has provided high quality eyecare to more than 300,000 patients – at prices that are 40% lower than the competition. We caught up with Javier on a recent Quest in Mexico City to hear about his journey from investment banker to social entrepreneur.

What led you to set up salauno?

I studied engineering, but I come from a family of entrepreneurs – it’s embedded in our DNA. I decided I first needed some training. So, the day I wrote my last exam, I got on a plane from Mexico to Madrid and started applying for investment banking jobs. I was lucky that I found a job quite quickly with Rothschild. Then I spent time in London and New York working for UBS and for a private equity firm specialising infrastructure.

In the meantime, I met my business partner, Carlos, who was working in investment banking. We read a book called the Fortune at the Bottom of the Pyramid by C K Prahalad. It has a case study about the Aravind eyecare system, which is the largest eye hospital in the world. We were really inspired by the way they combined social impact and profit. Not only were they subsidising 50% of the patients, but they were also financially successful.

We wanted to do something similar, but we needed to save up and get some experience. I went on working in private equity and Carlos went to do an MBA and an MPH (Masters of Public Health) at Berkeley. When he was finished, he called me up and said – “it’s now or never”. 

How did you get started?

I left my job and we spent about eight weeks at Aravind in India, learning about eyecare. Then, in August 2011, we started salauno with all our savings. Our combined experience in healthcare was only Carlos’s MPH. We barely knew anything! We started one clinic and made sure the model worked. Then we did some fundraising and opened a few more. We spent a lot of time at the beginning setting up the platform. Things like standardising processes, setting up systems, investing in people and training, setting up a good supply chain, etc. Now we can sustain fast growth, because we have that strong foundation.

What’s next for salauno?

We plan to grow to 67 clinics and three hospitals in the next 2.5 years – up from 18 clinics and one hospital at the moment. We just did our series B financing and we’re fully funded for that period. We’re also adding new services, like e-commerce, telemedicine and remote diagnostics. We’re very much walking down the line of technology assisted healthcare. For example, using of machine learning and AI for diagnostics and follow up care.

Growing a new business is tough. What keeps you going?

The main thing is that we’re working for a purpose. In terms of disability-adjusted life years, removing cataracts is the most impactful surgery in the world. It’s a low-cost procedure that allows people to become productive and to enjoy life. If you go and see the patients, you can see that what you’re doing is changing people’s lives. Believe me there have been quite a few moments of despair, but you look at your patients and you look at yourself in the mirror and you ask, “if I wasn’t doing this, then what would I be doing in my life? Would you go back to private equity?” And the answer is no. There is no better job than this!

How have you kept that sense of purpose as the company as grown?

We’ve focused a lot on building a purpose-driven culture. We have about 400 staff spread around central Mexico. One of the things that has helped is a platform called Workplace – a kind of Facebook for companies. For example, we have a town hall every two months through the platform and we post pictures of people doing things that reinforce our culture. We also have a system where you can get badges – like military stars and stripes – to add to your doctor’s coat. It’s worked phenomenally well both for staff retention and for patient experience. People are geared toward giving an extraordinary service and actually changing people’s lives.

What’s been a ‘wow’ moment for you?

What’s really incredible is that the lower the income group we serve, the more successful we are. The sheer need in low-income communities is huge. A few years ago, we opened a clinic in a very low-income area, thinking “if it fails, it fails; let’s see what happens.” We were quite surprised that it became our best performing clinic – and the more patients we see, the closer we get to our social-financial purpose . Now our business model is mostly about mass markets.

What’s your long-term vision?

We think we’ll have maybe 200 eye clinics in Mexico with six or seven hospitals. Then eventually we’d like to branch out into other specialities, like women’s health, cardiology, oncology. In 60% to 70% of healthcare the back office is very similar – managing infrastructure, volume, doctors etc.

We are also trying to build more public-private partnerships. If it takes people eight months to see a government ophthalmologist, why not refer them to us when have same day appointments? Why can’t we leave politics behind and make the system work? But there’s mistrust between both sides and bridging that gap is not easy. We’re making some progress. About 20% of our sales are from government contracts. We’ve been taking idle public infrastructure (eg clinics) and then refurbishing that and using it to give private services at discounted prices.

What would your advice be to somebody who wanted to start a social enterprise?

First, make sure that whatever you’re working for is something that you’re passionate about it. You need to be able to find the passion that will keep you motivated in the long-term to solve the problem. Second, find the right partner and build the right team around you. Third, keep investing in your leadership skills. The leader I had to be when starting out was one person; two years later when the company was struggling to grow it was another. Now we’re in a phase of fast growth, I need to develop different skills. I’m fully aware that I need a lot of training because the company is outgrowing my experience. I’m a street dog – I didn’t do an MBA!

What’s been biggest lesson personally?

One of the key traits that you need when you start a business is something that many entrepreneurs don’t have – patience. Because it takes a lot of time to develop a business model that works and scale it. So, you need to know it’s going to take time and sacrifices. Eight years into this company, I’m still earning a third of my private equity salary. It’s a personal sacrifice, but you do it because there’s also the emotional salary of working for something that’s truly meaningful. For some of us money isn’t as important as leaving a legacy.