Read the Conversation
EF: What mission have you set for yourself, and what do you aim to achieve while leading the emerging markets at Smith & Nephew?
BJ: Being born in an underdeveloped country and having part of my family as refugees gives me a strong sense of responsibility beyond my current role. I often think about how people can access healthcare regardless of their financial status or insurance coverage. If I were not financially privileged, how could we still receive the same level of care? This perspective shapes my goal and vision, especially when working in emerging markets covering 4.2 billion people, which is more than half the world's population. There is a significant challenge because where there is a large population, there is often a lack of financial resources, and vice versa. For example, countries like Saudi Arabia, the UAE, and Singapore have wealth but smaller populations, while many other regions have large populations but limited financial resources.
My meetings with CEOs and executives emphasize the need to "think global and act local." This means balancing corporate financial goals with modifying our offerings to meet local needs. If we cannot do that directly, we must find ways to adjust ourselves to provide access to healthcare. It is about maintaining a delicate balance in regions affected by geopolitical and economic instability, currency devaluation, and unrest. We must stay active and flexible, always having backup plans while focusing on patient-centric care. This commitment is rooted in my oath to serve patients and humanity.
In our diverse region, particularly at our Dubai headquarters, we have fewer than 50 people from over 28 nationalities. Managing such diversity requires fostering a culture of respect and harmony despite different ethnicities, beliefs, and backgrounds. This unique challenge is something I feel privileged to navigate.
EF: What trends are you identifying in emerging markets, and how do you balance resources to address these market needs across different business lines?
BJ: After COVID-19, corporations are now focused on maximizing their profitability. This drive for restructuring and optimization applies to healthcare and every other industry. As a result, there is more pressure on human resources, capital expenditures, or operating expenses. In emerging markets, which are full of opportunities, the situation differs from mature markets like Europe, the U.S., Japan, Australia, and New Zealand. While my colleagues in those regions focus on identifying new opportunities, my job in emerging markets is prioritizing them and ensuring our approach is consistent and not just opportunistic. I always tell my team we must build a sustainable, profitable, and compliant business. We should not make decisions that might deprive patients of our products in the future. For instance, we cannot install a knee replacement in a patient in Kenya and then exit the market a few years later, leaving the patient without support. This would not be morally responsible. So, when my V.P.s present their plans, I ask them where we will be in five or ten years, not just this year or next. I want them to show me the path forward and consider potential risks affecting their decisions.
The way this differs across business units is quite interesting. For example, orthopedics has three subdivisions: trauma, robotics, and reconstruction. Trauma is particularly critical in many parts of the world due to high rates of car and motorbike accidents and violence, like in South Africa, where gunshot wounds often result in traumatic bone injuries. Access to the market in this part of the world is somewhat limited, especially since many countries have developed local trauma care products, particularly in countries with low health budgets. This means our focus is often limited to specific regions for trauma care.
Reconstruction, however, is a huge business opportunity due to the increasing aging population and high rates of comorbidities like arthritis and vitamin D deficiency. These health issues often lead to the need for reconstruction surgeries. Primary healthcare in many of these areas is not well-developed, so patients usually seek treatment late, requiring more complex surgeries instead of simpler, earlier interventions. Although advanced and typically more expensive, robotic surgery is seeing significant use in countries like India and South Africa. This demand highlights the desire for advanced technology in healthcare, as robotic surgery offers higher accuracy and is less invasive. This is particularly important post-COVID, as patients prefer less invasive treatments to minimize hospital visits and reduce the risk of infection, especially in regions with a high prevalence of diseases like HIV.
In sports medicine, biologics are becoming more common, enhancing the effectiveness of surgeries by adding biological agents to repair tendons and ligaments. For example, using biologics has significantly improved my shoulder surgery recovery.
Wound management is also a critical area, especially in regions with high rates of diabetes, like Saudi Arabia and parts of North Africa, where diabetic foot infections are prevalent. Without proper treatment, these infections can lead to amputations, increasing the burden on healthcare systems and affecting the productivity of patients. Addressing these healthcare challenges requires more than just focusing on direct costs. We need to build capabilities and educate healthcare providers and payers on the long-term benefits of early treatment. This involves providing evidence that early intervention can reduce complications and improve outcomes rather than just focusing on immediate financial gains. For instance, we are launching new products like negative pressure devices for C-sections in wound management. These are essential for helping new mothers avoid postoperative infections and ensure a quick, healthy recovery. This is important for maintaining their well-being and their ability to bond with their newborns. Overall, it is about creating a balance between meeting the immediate needs of patients and building a sustainable, efficient healthcare system that can address long-term health challenges.
EF: Could you elaborate on the strengths and opportunities you see in the African market, particularly regarding AI and biologics?
BJ: Africa cannot be treated as a single entity and has to be seen through three distinct regions. There's South Africa and its neighbors like Namibia, Botswana, Zambia, and Mozambique, which have more advanced healthcare systems similar to that of the U.K. Then there's Anglophone Africa in the east, including Kenya and Tanzania, which are more developed than Central Africa but not as advanced as South Africa. Finally, there's West Africa and Central Africa, mostly Francophone countries, with similarities, except for more developed places like Nigeria and Ghana.
People everywhere want the best healthcare for themselves and their patients. This region is highly competitive, with surgeons, reps, hospitals, and countries all vying to be the best. Advanced technologies like robotics and biologics are in high demand despite being expensive. For example, in Nigeria, 5% of the 200 million population can afford top-tier healthcare and often travel abroad for treatment. The challenge is to provide the same quality of care locally to keep them from seeking treatment elsewhere. Data management is crucial because information is extremely valuable. Detailed data about patients, healthcare systems, and market shares allows for better strategic decisions. Advanced technologies like AI can help doctors by providing them with more information, but the cost and affordability are major factors. In emerging markets, it is about balancing affordability and capability. Imagine it like a car; it needs to get you from point A to B efficiently, but it does not need all the luxury features. The more expensive features you add, the smaller your market becomes. For instance, in South Africa, you might afford a luxury car, but simpler, more affordable solutions are needed in Nigeria, Kenya, or Egypt.
A.I. and digital marketing are popular buzzwords, connecting data points to predict outcomes. However, there is always a trade-off between the cost of advanced predictive tools and the effort and accuracy of human analysis. Sometimes, simpler and cheaper methods, like surveys conducted by team members, can provide sufficient accuracy without the high costs of advanced data services. To effectively reach and serve patients across different regions of Africa, we must be adaptable and consider each area's unique needs and economic conditions.
EF: What achievements in the emerging markets at Smith & Nephew are you most proud of, and what future opportunities do you see over the next five years?
BJ: I am proud of leading a team of nearly 1,200 people in this region, 5,000 lives I am responsible for if you think of it in terms of families. Helping them grow and improve keeps me awake at night. In emerging markets, people always aspire for better opportunities—like someone from India wanting to move to Singapore or someone from Dubai aiming for Europe. This constant drive for a better quality of life is natural. Translating this mindset is crucial. Look at global leaders like the U.K.'s Prime Minister, a third-generation Indian, or our CEO, who also comes from an emerging country. We must serve our surgeons well, educate them properly, and ensure that the global team sees emerging markets as talent pools. If we educate them here, they will carry that knowledge globally instead of turning to competitors. Strategically, we must equip our team right, aiming for them to eventually take on regional or global roles. Leaving a legacy in their lives is key. This is a continuous effort with always more to achieve. Keeping the team engaged, trusting in our mission, and recognizing growth opportunities is vital. Emerging markets are full of potential, and learning here can be valuable everywhere.
