The Sight of Sight For All
Image: “A well-managed operating theatre for high-volume cataract surgery at Aravind Eye Hospital. INDIA.” by R D Thulasiraj & S Saravanan, Community Eye Health. CC 2.0.
"Intelligence and capability are not enough. There must also be the joy of doing something beautiful. Being of service to God and humanity means going well beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient." – Dr. G. Venkataswamy
For one who is poor, for one who lives under $2/day, for one who has to work every day to feed the family, blindness equals death.
In India, like in other developing countries, average life expectancy after blindness is 2-3 years1. What makes this more striking is that 80% percent of all blindness in India (12 million) is needless – either can be prevented or cured2. What stands in the way is access to care.
With several competing priorities, there is a severe lack of facilities to treat the poorest of the poor for blindness at an affordable price. And even if there is such a facility, how does a poor blind mother of three get treated without dipping into the already diminished family income? Overcoming these hurdles is not an easy task because the problem is multifaceted. However it is not impossible either – and the Aravind Eye Hospital of India exemplifies this.
In 1976, Dr Venkateswamy (also known as Dr. V), at the age of 58, decided to give up all his life savings, mortgage his house, take bank loans and dedicate the rest of his life to eradicate unnecessary blindness2. To him, the problem was easy to solve. He wanted to devise a method to provide eye care like the way McDonalds devised a way to deliver affordable burgers all over the world (albeit with different health outcomes). "Supposing I can produce eye care and make it available in every corner, the problem of blindness is gone", he said. He founded the Aravind Eye Hospital in Madurai that year with 11 beds to provide care for blind patients, regardless of ability to pay.
Aravind is like no other facility on this planet – in fact, all Harvard MBA students have to do a case study on it. In the 36 years since its birth, Aravind has built 5 hospitals with 4000 beds in 5 cities – all with one mission: to "eliminate curable blindness". It is the largest and most productive eye care facility in the world1. They see 1.4 million patients every year and perform 200 000 sight restoring surgeries, most of which are done for no charge. The working model of Aravind is quite unique: every patient who comes to Aravind has an option of not paying for the services, regardless of the patient's financial background. Each patient who pays for the service (market price), pays for at least two patients who cannot pay2. There is absolutely no difference in the quality of care received between the paying and non-paying patients. The only difference is in accommodation. Surprisingly (or may be not so surprisingly), most people who can afford to pay do pay the full cost. Studies have shown that not only is the quality of surgeries performed in Aravind comparable to those of in the UK, Aravind does them at less than 1% of the cost1. Every aspect of Aravind has been maximized for service, not profit.
The biggest culprit causing unnecessary blindness is cataract. Up to 46% of all people are affected by cataract in the USA and up to 82% in India5. Although the cure involves only a simple one-time surgery, cataracts still lead to 50% of the world's blindness, mostly in developing nations where patients cannot either afford or access care6. And this is the barrier that Aravind is breaking. However, a major challenge faced by Aravind was the rising costs and availability of intraocular lens required for eye surgeries. In the early 1990s, each lens cost about USD 100, threatening Aravind's model. To overcome this massive roadblock, in 1992 Aravind started Aurolab, an on-site lens-manufacturing set-up. Its mission was to deliver ophthalmic products of world-class quality at affordable prices. As of 2012, Aurolab produces nearly 1.8 million lenses annually at a price of $2 each, exports them to 120 countries and holds 10% of the global market1. Ten million people in the world see through lenses from Aurolab.
The mission of Aravind is not only to provide care to patients who can make it to the hospital, but also to take eye care to the doorsteps of patients who cannot. Aravind has an extensive community outreach program that sets up eye screening camps by engaging with communities in the villages. These camps are run by nurses, who screen patients, provide basic eye care like eye exams and glasses, and decide which patients need further care. The patients who need surgery are transported to the hospitals. There they receive food, lodging, surgery, care and are finally transported back home. Between April 2011 and March 2012, 2831 camps were conducted; through which more than 1 million patients were screened, and around 85 000 patients underwent surgery in hospitals3.
However Aravind's quest to provide eye-care to all is constantly evolving as it keeps up with rapidly developing technology. In 2004, Aravind started setting up primary eye clinics in villages, providing people with the opportunity to access care as soon as they need it, instead of having to waiting until an eye camp was set up in the village4. The vision centers use tele-consultations – nurses run them with real-time video consultation with hospital-based doctors. The centers are completely paperless, and maintain all records on a centralized database. Each patient pays less than 50 cents for three visits. By 2011, these centers were receiving 160 000 patients every year1.
The unwavering growth of Aravind tells stories of one mission, of collective optimism and of several successes. As of 2012, Aravind has provided care to 32 million patients and performed 4 million surgeries – the numbers are high but they have only been able to target less than 10% of the 200 million people who need eye care in India2. Dr Aravind, (grandson of Dr. V) says that while they may have reached 40-50 % of what they are capable of doing, there is still a lot more to do. As one knows more and more about Aravind – one asks – how can an organization do so well and be so selfless and give away most of its services for free? Mehta and Shenoy, authors of Infinite Vision, say "The framing of that question tends to limit the scope of the answer. Aravind is an unconventional model that came into being – not despite, but because of – the deep-seated compassion at its core". Emanuel Nazareth and Laura Spencer (a board member of Seva Canada), who just visited Aravind Eye Hospital in Tamil Nadu exemplify that and say "every person involved in Aravind, starting from the one who holds the door to the surgeon has the same mission, the same dream. It is the culture that is cultivated there". Dr. Thulasiraj Ravilla of Aravind says the it is perhaps the building blocks set in place by Dr. V – the value system, efficient delivery process and fostering the culture of innovation.
“When we grow in spiritual consciousness, we identify with all that is in the world so there is no exploitation. It is ourselves we are helping. It is ourselves we are healing” – Dr. V
Aravind’s success has begun to spill over beyond its boundaries, and if curable blindness is to indeed to be eliminated, Aravind cannot be the only example. The organization systematically promotes similar practices in other hospitals, all over the world. In addition to helping the neighboring hospitals (basically their “competitors”), they have reached out to 270 hospitals worldwide. All over the world, millions die of preventable diseases like pneumonia, malaria, AIDS – perhaps we can pledge that Aravind will not be the only example. The model of Aravind is simple and is applicable to any developing nation with a market that needs accessible and affordable healthcare. All we need to do is own the problem, be compassionate and care. How tough can that be?
References:
An Infinite Vision: The story of Aravind Eye Hospital
Thulasiraj Ravilla. November 2009. How lost cost eye-care can be world class. [Video file]. Retrieved from http://www.ted.com/talks/thulasiraj_ravilla_how_low_cost_eye_care_can_be_world_class?language=en
Aravind Activity Report, 2011-2012. http://pubhtml5.com/idml/vwji
Aravind Eye Care System. Milestones. http://www.aravind.org/default/aboutuscontent/milestones
Garry Brian and Hugh Taylor. Bulletin of the World Health Organization, 2001,79 (3)
Prevention of Blindness and Visual Impairment. WHO. http://www.who.int/blindness/causes/en/