Legendary Effort Supplement livelihoods October 2016 Legendary Effort October 2016 Aravind Eye Care India did not have proper eye-care facilities to treat patients, even until the 1970s; it was during this time that Dr. Govindappa Venkataswamy, who was working then with Madurai Medical College (MMC) as Head of Ophthalmology Department, established GOVEL Trust in 1976 after his superannuation at the age of 58. Thus, the first Aravind Eye Hospital emerged in Madurai, with a modest 11-beds hospital in a home. The hospital was named after Sri Aurobindo, a freedom fighter and spiritual leader from India. Aravind Eye Care ( 1 )
In 1976, Dr. Govindappa Venkataswamy, famously known as the Dr. V, started the Aravind Eye Hospital in Madurai. Dr. V decided to devote his retirement years to eliminate blindness among the India s poor; as around 12 million people go blind in India due to cataracts, and it mostly strikes individuals before they turn 60 in India, which is earlier than in the west. In the case of poor persons, blindness not only robs them of his/her livelihood but also a sense of self-worth. India did not have proper eye-care facilities to treat patients, even until the 1970s; it was during this time that Dr. Govindappa Venkataswamy, who was working then with Madurai Medical College (MMC) as Head of Ophthalmology Department, established GOVEL Trust in 1976 after his superannuation at the age of 58. Thus, the first Aravind Eye Hospital emerged in Madurai, with a modest 11- beds hospital in a home. The hospital was named after Sri Aurobindo, a freedom fighter and spiritual leader from India. Setting up the Hospital wasn't an easy task as most of the banks refused to lend money citing Dr. V s age, and the eccentric business model; in which six beds reserved for people who could not afford to pay, while the remaining were for patients who could afford payment. This model was not appreciated by private lenders too, thus he could not raise the money, but Dr. V s family members played a very crucial role in establishing the eye hospital, and facilitated its growth and gradual success. Dr. V had not only been a wonderful doctor, humanitarian, but was an orderly man who strived for efficiency and excellence. The effectiveness of McDonalds fast-food centres, which served a huge number of people without compromising on quality, struck Dr. V, and he wanted to emulate it in his service to people and sought to adapt it to the eye-care system to cope with increasing numbers of patients to be treated. The need for eye-care to the poor was so significant to Dr. V, that when the Hospital began performing surgeries on a large scale with treatment being free or heavily subsidized for the poor cross-subsidized by paying patients. The Hospital also established an outreach program wherein doctors reached out to remote villages to conduct eye camps, sponsored by various organizations such as SathyaSai Organization, Lions Club International and Rotary International. The organizations took care of the costs of the camp, transporting the patients to surgery and their rehabilitation, the Aravind Eye Hospital performed surgery free of cost. With time their work kept on growing, so much so that Aravind began performing five times the number of cataract surgeries that were performed in the entire country and 16 times more than that of the entire US. The Aravind Eye Hospital, in the process, established its own lens manufacturing facility, Auro lab and blood bank to reduce costs. The Hospital focused on rotating doctors between free and paid wards, concentrating on efficiency and hygiene; thus, eliminating the difference between the surgeries done for paid and non- Aravind Eye Care ( 2 )
paid patients. The rate of infection in Aravind was about four per thousand surgeries, which was significantly lower than the international norm of six per thousand surgeries. The model, which was earlier rejected by many, gradually made the treatment of eye sight extremely affordable to the common man. The Hospital made its aims and objectives very clear in the areas of procurement, process and distribution of corneal tissues of the highest quality of transplantation, provision of eye tissues for research and training, providing support and grief counseling to donor families, promoting awareness programmes among the public and equip the personnel. As the Hospital model was scaling up, it had also set up an Eye Bank with the following functions: a) procurement of eyes; b) processing of eyeballs; c) distribution of corneal tissues; d) training to eye bank technicians and corneal surgeons; e) promote public relation activities; f) provide eye tissues for training and research. With the distinct advantage of having links with various organizations like NGOs, Lions clubs, Rotary clubs, Aravind Hospital developed the procurement model, trained the personnel of the Eye Bank adequately, and also setup Eye Donation Centers and contributed to the Eye Bank by procuring at 35 collection centers across 12 districts of Tamil Nadu. The processing wing at the Hospital has to work in different stages, which are: 1. Processing of the donor tissue i.e., eye ball collection (enucleation); 2. Serology Test; 3. Evaluation using Slit Lamp; 4. Excision of the cornea; 5. Cornea evaluation under keratoanalyser; 6. Slit Lamp Evaluation; 7. Endothelial cell analysis; and 8. Documentation. The documentation helps in maintaining the proper track records for the utility of the tissue, and it also helps the hospital to review the statistics and eye banking mechanism. As the Hospital scaled up its activities from a 11- bedded hospital, it moved into the area of distribution, and developed a clear cut distribution policy having priorities which included; tissues needed by the Cornea service, Aravind Eye Hospitals; tissues needed by the Corneal surgeons in the district and tissues needed by other states. As on today, the Eye Bank distributes 10% of its collection to other eye hospitals in various parts of the country, and they are as follows: Aravind Satellite hospitals. S.S.Borda Eye Hospital, Bhuvaneshwar, Orissa M.P.Birla Eye Hospital, Calcutta Sri Aurobindo Research Centre, Raipur. A.K.Soni Eye Hospital, Jaipur Aravind Eye Care ( 3 )
Modern Eye & Xray Clinic, Chattisgarh NarayanaNethralaya, Bangalore Sankar Foundation New Eye Hospital, Vishakhapattinam Tamilnadu Ophthalmic Association (TNOA) Lions Eye Hospital, Goa Government Hospital, Madurai Ophthalmology Dept, Patna Government Rajaji hospital Sankar Foundation, Vishakhapattinam Srikiran Institute of Ophthalmology, Kakinada Suraj Eye Institute, Nagpur DRR Eye Hospital, Chennai Darshan Eye Hospital, Chennai Lions Eye Bank, Goa Aravind Dr. Venkatasamy Research Foundation, Madurai Indira Gandhi Eye Hospital, Amethi Camps & vision centres The operational efficiency is the cornerstone of the hospital, as a vast majority of people go blind from cataracts in rural India and have no idea as to why they are going blind; Aravind decided to spread awareness to poor patients in two ways, firstly it holds eye camps, 40 a week around the states of Tamil Nadu and Kerala, and offers eye examinations, basic treatments, cheap glasses, etc. Patients requiring surgery are invited with a family member to come to the nearest of the Aravind s nine hospitals, all transport and lodging, including surgery is free. One of the key moments in Aravind s journey was when they undertook a survey about the reach and the impact of its camps, and found to their utter dismay that they managed to attract only around seven percent of all the people who needed care in villages, even they were infrequent. Thus, to have a permanent presence in rural areas, Aravind established around 36 storefront vision centers which were staffed by rural women who were imparted training in rural areas. They have also set up cameras so that the doctors at Aravind s hospitals can do examination remotely. This resulted in increasing the penetration to 30 percent within one year of operation and saw an increase in Aravind's market. From its humble beginnings as a small eye hospital in Madurai in 1976, Aravind Eye Hospitals have been started in many places to serve the poor. In 1985, a hospital has been opened in Theni, one in Tirunelveli in 1988,one in Coimbatore in 1997, and gradually it expanded its presence to five more cities in Tamil Nadu i.e., Salem, Tirupur, Dindigul, Thoothukudi, Udumalaipettai and in neighbouring Union Territory Pondicherry. By 2015, it had set up a hospital in Chennai at the cost of 1.4 billion with a capacity to perform 60,000 surgeries a Aravind Eye Care ( 4 )
year. It had spread its wings internationally by setting up an overseas venture in Nigeria in partnership with Chanrai Group; thereby, setting up the largest eye-care facility in Africa with a capacity to perform 10,000 surgeries annually. The scalability of the Hospital grew to such an extent where the group also had developed four partnership projects with the Rajiv Gandhi Charitable Trust in Amethi, Birla Corporation in Kolkata and Shanghvi Trust in Amreli, Gujarat. Though appreciating its scalability and replicability, the hospital had its own set of challenges and some of the key challenges were in the areas of rising costs and availability of intraocular lenses required for eye surgeries that threatened its basic model. A new surgery which implanted a lens in the patient s eye had become the gold standard for treating cataracts, and these lenses were not made in India; the most challenging aspect was that Aravind could persuade manufacturers to reduce lens cost from $ 100 to $70 per lens only. Therefore it faced a major moral dilemma, should Aravind begin providing first-class treatment for paying patients and second-class treatment for free ones, or should it try to get enough money from paid patients to cover intraocular lenses for all. Neither of it was acceptable to it. To cross this hurdle, Aravind sought the assistance from American entrepreneur David Green and WHO, and came up with the idea of Auro lab, an on-site lens manufacturing which was then set-up near Madurai. As on 2012, the lab produced nearly 1.8 million lenses annually at a price of only $ 2 each. Due to the availability of cheap lenses, Aravind has been able to perform many more surgeries at each of their Aravind Eye-care Hospitals. In a similar model, the hospital had also established Lions Aravind Institute of Community Ophthalmology (LAICO) in association with Lions International in 1992, with an aim to offer premium training to hospital administrators, hospital operations managers and other management professionals. As on today, the eye hospital has grown into a network of eye hospitals and has had a major impact in eradicating cataract related blindness in India. According to figures in 2012, the hospital has treated nearly 32 million patients and has performed 4 million surgeries. Moreover, the hospital has made these surgeries cheap or free making it is the world s largest and most productive eye-care service groups. The Hospital has never indulged in advertising, but still managed to garner a profit of $ 7.9 million on overall revenues of $ 20 million in 2009-10 itself. Today, the eye-care system is a network of hospitals, clinics, community outreach efforts, factories and research with training institutes, and this has not just been a health success but a financial success, where the core services are sustainable. A noteworthy fact is that the majority of Aravind s patients pay only a symbolic amount or nothing at all. It is amazing to note that Aravind does 60 percent as many eye surgeries as the UK s National Health System at one-thousandth of the cost; it truly hosts a parade of people who come to learn how it works, and sends it staff to work with other organizations. Aravind Eye Hospitals have created a social innovation in health care and have shown the way to many more individuals and organizations to replicate the model. After seeing the success of the model, many other institutions that have cropped up, including Wasan eye-care, Vision Express, Tata Eye Plus and many more, but largely with commercial orientation. This vision of Dr. V literally gave and continues to give vision to millions of rural and urban poor; thereby, improving their livelihoods and self-worth!! Aravind Eye Care ( 5 )