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Eye Hospital in India Restores Sight with Free Surgeries

September 2, 2009 at 12:00 AM EST
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Special correspondent Fred de Sam Lazaro reports from India on the Aravind system of eye hospitals and clinics that subsidizes sight-restoring surgery for impoverished patients and provides top-of-the-line care for patients who can pay.
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JIM LEHRER: Finally tonight: bringing sight to millions of people who suffer from eye disease.

Special correspondent Fred de Sam Lazaro returned to an eye hospital in India that he first visited in 1989.

FRED DE SAM LAZARO: Aravind is the largest eye care center in the world. The surgical facilities are as modern, the error rate as low as any place in America.

The big difference with Aravind is that its patients are among the world’s poorest people, who rarely get treated for eye diseases. Globally, 45 million people have preventable or reversible blindness. Twelve million are in India alone, where the extreme sun and genetics are blamed.

Many people lose their sight and livelihood by their early 50s. Aravind’s business success and social mission have long made it a model in public health textbooks. Twenty years ago, this much younger reporter came to the ancient temple city of Madurai, where Aravind was founded by Dr. Govindappa Venkataswamy. Everyone called him Dr. V.

He retired from a government hospital in 1976 and set out to tackle what he called disabling cataract blindness.

DR. GOVINDAPPA VENKATASWAMY: Nothing which disables a man like cataract and poor eyesight.

FRED DE SAM LAZARO: Aravind itself was a very small operation when Dr. V. started it, with 11 bed and four doctors, three from his own family. The idea was simple. They would serve patients who could pay. The profits would afford free care to the many more people who couldn’t afford even the bus fare.

So, Aravind set out to find patients, mainly through screening camps in surrounding rural areas. Groups like the Lions Club provided buses to bring those needing surgery to the hospital, where they entered a brisk assembly line operating room.

Dr. V.’s business role model was McDonald’s, or American chain stores in general.

Maintaining a legacy

DR. GOVINDAPPA VENKATASWAMY: In America, you have models, whether it Sears tools or McDonald's hamburger or -- you are able to open a chain of shops or restaurants or hotels.

DR. ARAVIND SRINIVASAN, Aravind: You spoke to him here. You were sitting here, and he was sitting there and talking about McDonald's.

FRED DE SAM LAZARO: Dr. V. died in 2005, but his office is left untouched as a shrine to him. His nephew, ophthalmologist Aravind Srinivasan, manages a system that's grown to five regional hospitals and 25 satellite clinics. This was the first one.

DR. ARAVIND SRINIVASAN: This is a 32-year-old hospital. Today, we are about 1,500 to 2,000 patients a day.

FRED DE SAM LAZARO: Each pays about $1 for a doctor's appointment. That helps fund even more patients, who go next door to a free eye hospital. There's not much profit margin, so a heavy volume of paying patients, satisfied patients, and efficiency are critical.

DR. ARAVIND SRINIVASAN: We call this a clinic scoring sheet.

FRED DE SAM LAZARO: Dr. Aravind, who also has an MBA from the University of Michigan, has continuous productivity reports at his fingertips.

DR. ARAVIND SRINIVASAN: And this statistics talk about service time. How many -- what percentage of people were seen within two hours?

FRED DE SAM LAZARO: Patients are promised a completed appointment in two hours and a brochure detailing what they can expect.

DR. ARAVIND SRINIVASAN: So, registration takes about five minutes. Vision test takes about 10 minutes, refraction check about 10 minutes.

FRED DE SAM LAZARO: So, this is sort of like a patients' bill of rights almost?

DR. ARAVIND SRINIVASAN: Exactly, so they understand what's happening.

FRED DE SAM LAZARO: Aravind's reputation is drawing patients from farther and farther away.

MAN: Whenever you say eye operations, everyone says, go to Madurai.

FRED DE SAM LAZARO: It's the only reason 55-year-old K.G. Angenealou was coaxed out of a three-year depression that began when cataracts started clouding his vision. He became completely blind three months ago. Angenealou and his wife, Shoba, endured a two-day train journey get here.

MAN (through translator): I was a sportsman. I used to swim. After the cataract, I could no longer move around. I got stuck at home, and I started eating. Then a leg injury made me even more immobile. I had problems being overweight. And I developed high blood pressure.

FRED DE SAM LAZARO: By 9:00 the morning after arriving here, he was being prepared to surgery. Already, dozens of patients had gone ahead of him.

So, you have been going for two hours, and you have done 16...

DR. ARAVIND SRINIVASAN: Patients, yes?

Expanding the clinic

FRED DE SAM LAZARO: Dr. Aravind and surgeons in several operating theaters were first working the routine, mostly cataract cases. The more complex ones, like glaucoma and corneal surgery, would come later.

DR. ARAVIND SRINIVASAN: It's an entire teamwork, as you have seen in the front. I'm seeing the patient for the first time in the O.R. So, somebody has done a thorough workup of the patient. And any challenging cases, they show to me earlier. So, we are able to identify our -- those cases which need a little more extra attention is segregated from the whole.

FRED DE SAM LAZARO: Angenealou was one such case, his hypertension and obesity posing extra risks.

DR. ARAVIND SRINIVASAN: You just have a margin of safety of about five to 10 minutes to get the surgery done.

FRED DE SAM LAZARO: About 10 nervous minutes later, Dr. Aravind had removed a particularly tough, leathery cataract.

DR. ARAVIND SRINIVASAN: The cataract was a little obstinate, but, otherwise, things went on well. So, when you see him tomorrow, you will see a different man, more confident.

FRED DE SAM LAZARO: By the end of this day, Dr. Aravind and his colleagues did about 300 surgeries, about half of them free of charge.

Increasingly, however, patients are seen outside the hospital. Telemedicine connects doctors to satellite clinics. And today's eye-cams offer much more on-site, from grinding eyeglass lenses to digital scans. Near this camp, a satellite truck beamed high-resolution images to doctors at the hospital. It's especially useful in diagnosing India's growing problem of diabetes-related eye disease.

Technology has improved care and it's also brought down costs, notably for the intraocular lenses which are implanted during cataract surgery. They used to be imported.

Aravind began making its own intraocular lenses back in the early 1990s. They used to cost between $50 and $100 each. Today, they are made in this factory for as little as $2 apiece. Aravind lenses are exported to 120 countries, and they own 8 percent of the global market in intraocular lenses.

Whether it's supplies or people, the goal is to be self-sufficient. Aravind now have extensive training programs for recent medical graduates. It also trains thousands of mid-level ophthalmic professionals, mostly women from surrounding rural communities. Some 250 hospitals across India and 40 other countries have adopted Aravind's methods.

R.D. Thulasiraj manages the teaching facilities.

Becoming more efficient

R.D. THULASIRAJ: In this institute, we train organizations to become more efficient. We -- we completely give our intellectual property... Now, they're -- we open up our systems, processes, our -- how much we charge the patients and our records.

FRED DE SAM LAZARO: It's the ethos set by his uncle. Dr. V., who was single, never took a salary. In fact, he mortgaged his home to start Aravind. And he coaxed or inspired 34 members of his extended family to work here, starting in 1976 with his sister Natchiar and her husband. Both left surgical careers in America to work here for about $20 a month.

DR. G. NATCHIAR: Today oh, my God, we are very, very happy. In fact, at that time, in the '80s, we were not happy. Even though Dr. V. was happy, in a family life, you know, like me and my husband, two children, it was not easy for us. We couldn't even buy a cycle. At that time, we didn't appreciate his far vision.

MAN: God bless you, madam.

DR. G. NATCHIAR: God bless me. Yes, God bless the surgeon.

FRED DE SAM LAZARO: She says the satisfaction of seeing patients like Angenealou restored to full lives makes up for any material privation, although, over the years, salaries have greatly improved for the 220 doctors and some 2,500 other Aravind staff.

MAN: My children are starting school on the 1st, so I want to get going.

DR. G. NATCHIAR: We will give you some dark glasses, just like a Hollywood actor.

FRED DE SAM LAZARO: He's one of 27 million patients who have been treated at Aravind and 3.4 million who have had surgery, surgery that now costs just a few dollars more than a meal at McDonald's.

JIM LEHRER: There's more about the Aravind clinics on our Web site, NewsHour.PBS.org. You can see a slide show of images, read a reporter's notebook, and watch Fred's exclusive online report about the partnership that helped those hospitals grow.