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Two Decades On, India Eye Clinic Maintains Innovative Mission

BY Talea Miller  September 2, 2009 at 4:27 PM EDT

Aravind Eye Hospital

The Aravind Eye Care System is an island of cutting edge technology amid the cows and chaos of India, another business success story in one of the world’s leading emerging economies.

There is one critical difference about Aravind, however: Its customers are some of the world’s poorest citizens.

I first reported on the then-Aravind Eye Hospital in 1989 for the then-MacNeil/Lehrer NewsHour. In fact it was the first foreign story I ever filed for this program. So it is a thrill to return two decades later to the ancient temple city of Madurai, where Aravind has grown into a campus of several buildings to become the world’s largest provider of eye care services, the winner in 2008 of the $1 million Gates Prize for Global Health.

The mission has remained simple: to eradicate needless blindness. Around 45 million people worldwide suffer from blindness, most of it curable or preventable. A number of factors – ultraviolet radiation exposure, genetic predisposition -make people in the Asian subcontinent particularly vulnerable at relatively younger ages to cataracts. Millions of Indians lose their sight in their fifth decade.

The late ophthalmologist Govindappa Venkataswamy founded Aravind in 1976, after he retired at fifty-five from the government hospital in Madurai. Dr. V, as he was widely known, combined a religious zeal to serve and his fascination with businesses like McDonald’s and the “other chains you have in America” that were able to provide a uniform product on a massive scale.

Methodically, he built on the concept of high quality assembly line patient care, forging close ties to public health experts at the University of Michigan and to the Berkeley-based Seva Foundation. If he sought charity, it began – literally – at home. Aravind’s first rented quarters and its early building and expansion were funded by a lien on his home. Dr. V, who was single, never took a salary and convinced several members of his immediate family to join the effort. His sister G. Natchiar and her husband, P. Namperumalsamy, who had both completed ophthalmology fellowships at Harvard, gave up paths to thriving careers in America to return to Madurai.

Aravind began by offering care to paying patients, using the proceeds to offer free care to those who could not afford it. Twenty years ago, I witnessed the early lesson they were learning about the difference between offering free care and actually providing it. Free care is not free if the patient cannot afford transportation to come to the hospital and must ask a sighted relative to chaperone, at the expense of several days’ lost wages. So Aravind doctors began going out to villages to conduct eye camps. The Lion’s Club International chipped in, providing buses to bring patients who needed surgery to the hospital.

Twenty years later, the system to serve such patients is both logistically and culturally refined, the stuff of textbooks. Aravind has a 600-bed free hospital, its own buses and a cadre of ophthalmic assistants, specially trained on its campus. These young women, drawn from local communities, are able to win the confidence of patients and accompany them every step of the way – from the first examination through surgery, discharge and the return bus ride home.

Aravind-trained paraprofessionals also staff regional clinics that are linked via Web phone to doctors at the Madurai hospital. A roving satellite truck brings radiology to village eye camps, beaming high-resolution images back to specialists at the hospital.

To date, Aravind doctors have treated 27.4 million outpatients and performed more than 3.4 million surgeries, in architecturally simple but technologically sophisticated – and sparkling clean – facilities. Aravind’s error rate, around one percent, compares favorably with any American facility. Revenues from paying patients continue to support free care (on average one paying customer supports four free).

Perhaps the loudest testament to Aravind’s self-reliance and its growth is the massive new Aurolab factory. It produces intraocular lenses, which are implanted after cataract removal. When doctors here began using these lenses in the early 1990s, they cost $50 to $100 a piece. Aravind’s low costs and efficiencies instantly lowered that price to ten dollars. It now garners eight percent of the global market, exporting to 120 countries in the developing world. Aurolab lenses – tested to meet exacting international standards – now sell for as little as $2, about the price of a McDonald’s hamburger.

Since the Aravind piece in 1989, I’ve reported on numerous social enterprises and a worry many share is how to continue growing – or in some cases just survive -after the passing of a charismatic founder. Dr. V, who died three years ago, may have assured this by convincing no fewer than two dozen from his immediate family to work here. It’s a much easier sell in what today is a world-class institution that pays competitive salaries.

His successor at the head of the hospital is a 40-year-old nephew; an ophthalmologist who also has an MBA from the University of Michigan and also bears the name, Aravind, after the well-known spiritual leader Sri Aurobindo, whose teachings inspired Dr. V.