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The McDonalds of Healthcare: Aravind Eye Clinic in Southern India

The above video is from the Unite for Sight Conference. The woman speaking, Pavithra Krishnan, filmed an amazing documentary on her grandfather, Dr. V. I hope to put the documentary online as well for all to see. It’s an amazing story of doing well by doing good.

About the speaker:

Pavithra Krishnan - Dr. V. and Aravind Eye Clinic

Aravind Eye Care System of Sustainability
“Infinite Vision - The Story of Dr. V(enkataswamy) and the Aravind Eye Care System,” Pavithra Krishnan, Filmmaker
“High Volume Cataract Surgery at Aravind Eye Hospital - A Film By Dr. Venkatesh, Aravind Eye Hospital, A Unite For Sight Partner”

Pavithra Krishnan, Filmmaker
Pavithra Krishnan is a writer/first-time filmmaker from South India. An English major with post-graduate training in Broadcast Journalism from BBC World, she interned with a small production company in New York before returning to India to work freelance on short films and writing projects for non-profits. Her poems, essays, articles and short stories have appeared in various Indian magazines. Infinite Vision is her first documentary and was made with a very small volunteer crew and a vast army of well-wishers from around the world. The journey of its making brought her into an awareness of - the way the world changes when we change the stories we tell.

Pavi also works with Video Volunteers, a NY-based non-profit that seeks to connect storytellers from the world of film and video with grassroot causes in developing countries. Until recently she held the position of Communications Director with The Aravind Eye Care Institute in India. In addition she is a core member of CharityFocus, a volunteer-run non-profit and ‘incubator of compassionate action’ based in California, that among other things, works towards sharing stories of service and inspiration with the world.

Pavi just recently moved to the United States and now lives in the Bay Area with her husband. She is currently working on a book that will further explore the history, evolution and working of the Aravind Eye Care System. It is her aspiration now, in some small way through the telling of this story to inform, interest, but above all inspire audiences, and to help share the story of Dr V’s life and work.

Here is something I wrote right after the Unite for Sight conference…

i was @ Yale University last weekend web casting a conference for Unite for Sight. Unite for Sight’s mission is to eradicate preventable blindness world wide. the idea is that many people, especially in third world countries, go blind due to things that, if treated, are preventable.

one example is cataracts. cataracts cloud the eye so that eventually you can’t see. but cataract surgery is a simple procedure, and once complete, vision is restored.

the problem is that many people in places like india, africa, and asia don’t have access to running water, let alone an opthamologist who can perform this simple procedure. one of the speakers, an opthamologist in west africa, said that he is the only eye care specialist for a population of 2 million people. crazy stuff. i think new york has an eye doctor every two blocks. mine is across the street at lens crafters.

the productivity lost globally due to blindness is staggering. when someone in a village goes blind, they can no longer productively contribute to the community. often times family members have to take care of them, which is a further drag on the family. the life expectancy rates for someone who goes blind in the third world is a few years. if you can’t work or feed yourself in the third world, death is not far off.

some of the thought provoking ideas discussed at the conference revolved around sustainability. the idea that a western doctor travels to a third world country to perform surgery for two weeks is noble. but that is not a sustainable model. the doctor may help 200 people. but there are 40,000,000 blind people globally. and the rate of new cases of preventable blindness is far above the number of surgeries performed each year in the third world.

what that doctor needs to do is transfer skills and knowledge to local people who can then continue to help others long after the doctor leaves.

a related goal is to push down costs so that corrective surgery is within the grasp of poor people. this seems unrealistic, but it actually is not. An amazing documentary, which i will hopefully be able to put on the conference web site (http://uniteforsight.scribestudio.com) is about the Aravind Eye Hospital in southern India. From their Web site (www.aravind.org):

Under the leadership of Dr. G. Venkataswamy, Aravind Eye Hospital was founded in Madurai in 1976 with the mission to eradicate needless blindness in Tamilnadu.

the business model first focused on eye surgery and care. then it expanded to actual manufacturing of low cost lenses because the lenses produced in the west were too expensive.

Dr. V was greatly influenced by the McDonalds business model. A chain business that provides the same quality & product no matter which restaurant you go to. in addition, McDonalds mastered the assembly line. they can serve high volumes of customers with consistent quality product at a low cost. i guess you can call this a positive outcome from the exporting of the fast food nation poster child to the rest of the world.

Dr. V. wanted to apply the same methodologies and processes to eye care. he also wanted to adopt the chain concept (they now have 5 clinics). Aravind does a few interesting things that work (the company is profitable and serves hundreds of thousands of poor patients).

first, it never refuses a patient. poor people pay what they can. sometimes people even pay using alternative currency, such as a chicken. if someone can’t pay before the surgery, perhaps they can pay after the surgery, once they become a productive member of the economy again and start to get back on their feet. i think their enormous gratitude prevents most people from being delinquent.

second, wealthy people are expected to contribute more - a two tiered pricing structure. for every one surgery done on a wealthy person, the hospital can afford to do many free surgeries. wealthy people fly in from all over the place because Aravind is the best eye hospital in the region. it is not the hospital for poor people, like the county hospital in Oakland with the private hospital across the bridge in San Francisco. it is simply the best hospital around. and that attracts everyone.

the hospital staff is specialized and each person has a role to perform to take the huge amount of daily input (hundreds of people walking in the front door each day) and convert it to output (newly seeing outpatients).

in addition, the surgery techniques have been refined to handle high volume without sacrificing quality.

western techniques and expensive high tech equipment need not apply. an example is sutureless surgery, which requires no stitches, therefore saving time. also, two patients enter the operating room two at a time and the doctor swivels back and forth between the two while the sous chefs prep each patient.

many american opthamology residents have remarked that they learned more at Aravind than they ever learned during their US residency. old school surgery techniques, long abandoned in the west, combined with a few innovations, are the norm. surgeons in the US are kind of like me…i can’t add anymore because i rely too much on calculators and excel. when i have those tools at my disposal, i’m great. when i don’t i’m s…l…o…w.

instead of forcing blind people to come from hundreds of miles away, often accompanied by a family member (who loses a day of work and has to pay the bus fare of two people rather than one) to guide them, the clinic provides buses that pick up many people at once early in the morning and drive them back to their local community once the day is done.

one thing i have been enamored with lately is solar power.

i had a long conversation with Cathy Schanzer, who runs an eye clinic in Sierra Leon. during Cathy’s presentation, she talked about her clinic, some of the same themes discussed above, such as transferring knowledge to make the clinic self sustainable, etc.

one challenge the clinic has is providing power. each week a truck drives many miles to fill up drums of gas to bring back to the remote clinic to power the gas generators.

but i noticed that it looked really hot and sunny in every picture in her presentation. hello solar power.

i’ve been talking to my friend brandon recently who works for a large solar power company about ideas i have to push solar power adoption at the consumer (a home owner) level. last year, i wanted to put solar panels on my parents roof to power some simple things like the microwave, stereo, etc. and then, once i leanr from that experience, to jump feet first and deck out the whole roof.

unfortunately, when i did a google search on solar power, there wasn’t much information for non-technical people when it comes to helping people build confidence that they can put solar panels on their roof.

so what i said to brandon was (since my company is a streaming media and e-learning company) let’s do an install (brandon and myself) and film the experience. the video footage would then be put online in the form of a free online course that shows people how to do it.

taking this same idea to the clinic in Siera Leon, and keeping sustainability in mind, i thought maybe we could do the same thing with remote third world hospitals. brandon and i go to sierra leon with cameras and equipment and someone from his company that is more technically oriented than brandon or myself, and film ourselves installing panels on the roof of the clinic.

the clinic would not pay any money up front but would start to pay a monthly fee. the goal is to replace the burdon of a heavy upfront cost, which is the knock on solar, with a more user friendly monthly fee. so brandon’s company does not become a charity, but a bank that has a loan outstanding…a financing company. they actually can make money and do good.

then, other clinics can watch the video, online or on dvd, and see that it is possible to install solar at their clinic as well. this is microfinancing at its best. a clinic that spends $100 per month on gas can now spend $100 per month on solar, or maybe even less.

we could even set up a donate now link on the free online course and show people which clinic they are donating funds to for solar panel installation.

anyway, right now i’m web casting a security industry conference in las vegas. back to work…

This article was created by the editors and producers at ScribeMedia.Org.