Life in the Retina Clinic Part 2: Safeguarding Aravind’s Contradictory Commitment

Last Saturday was an ordinary evening at Aravind – thousands of patients screened and hundred of surgeries conducted. It was simply a typical day at the largest eye hospital in the world where the extraordinary is the norm. The one exception was the main room in the expansive Dr. Venkataswamy Eye Research Institute. Normally a large portion of the research building sits vacant as the once bustling hospital building-turned research institute requires a fraction of the available space. That night, the lights were on, fans spinning precipitously and laboriously cutting through the stale air as people from across the hospital streamed into the makeshift auditorium. Sisters (nurses) in their multi-hued saris dotted the seats and doctors hustled in after seeing their last patients.

Why would around 100-150 personnel meet in the normally vacant room half hour before the end of the work week?

It was Dr. V Day, the annual half memorial-half celebration of Aravind’s founder. Fittingly, the 6th anniversary of his death was marked by the values and ideals he instilled throughout the organization.

I sat towards the back with Sindhu and Christina, which offered us a view of the entire ceremony although admittedly, I couldn’t hear or understand any the speakers’ Tamil. However, I needed no translator to observe how the concise ceremony embodied Dr V’s dream and values. No superfluous details, pomp nor self-congratulatory speeches would be observed or heard. That was neither how Dr. V lived nor how he would be memorialized. Instead he spoke by actions, dedicating his life’s work to preventing needless blindness, achieving best-practice driven outcomes that far surpassed initial doubters (take this fact for example: Aravind expects all its hospitals to turn a 40% operating profit each year. They do.) Likewise the memorial service was concise and straight-forward, yet still managed to be a moving memorial to Dr V. It was all over after a 10 minute video produced by Sindhu (link below), a speech, silent prayer and three songs. Everyone pushed back their chairs, found their sandals and left. Nothing more.

We were one of the last to leave as if we were a little startled by the memorial’s brevity. Perhaps we half believed everyone would return, but the empty room and silence made perfect sense after a few moments. Nothing more was needed to be said while so much remained to be accomplished by the organization tasked with eradicating needless blindness.

***

Afterwards I couldn’t help but contrast the memorial service with the Retina clinic where Christina and I work. Her last post summarized our project (and problems faced) so I won’t rehash that one, though our project illustrates how the clinic is a prime example of Dr. V’s contradictory vision for Aravind: high volume, yet patient-centered care. The Aravind model aims to treat all blindness, reach all patients regardless of geographic barriers, costs or illness type. Thus Aravind aims to gradually expand its hospital system and patient volume while maintaining their high standards of care.

Aravind’s lean business model works though the Retina clinic is starting to show cracks in Dr. V’s cherished ideal. Retinal illnesses and surgeries are far more complicated than cataract surgeries – the backbone of Aravind’s work – while chronic diabetic retinopathy can only be managed not cured, preventing further sight deterioration.

The problems are then compounded by India’s changing demographic and epidemiological conditions where the country’s increasing diabetic burden is fueled by urbanization, adoption of westernized foods and the emerging sedentary, service-driven economy. Already India suffers the highest burden of diabetes in the world, igniting a chain reaction: increased patient volume drives longer wait times, causes cramped clinics, decreased doctor-patient face time and surgical acceptance rates and ultimately, raises questions about Aravind’s commitment to Dr. V’s high volume patient-centered philosophy. Why should paying patients who ultimately subsidize and thus enable need-blind care choose to wait 3-4 hours to see a doctor for 5 minutes and then a pre-surgery counseling appointment for another 5 minutes for a surgery that rarely restores sight? Patients not hampered by financial constrains may choose a private hospital offering personalized care, quiet rooms and no wait, eventually plunging Aravind’s entire pay scheme into doubt.

Aravind’s future success rests on its ability to act proactively. Can Aravind’s model be adapted to managing complex, chronic conditions while maintaining its contradictory commitment to high volume, patient-centered care? I don’t know nor do I have the answer, but I’ll put my money with Aravind because of the organization’s historic ability to innovate. If Dr. V taught the world anything, it was that a commitment to a dream, gut determination and investing in people allowed an 11-bed hospital to grow into the world’s largest eye care provider in less than 30 years. That makes fixing the Retina clinic look like child’s play.

Sindhu’s video for Dr. V: https://www.youtube.com/watch?v=xbgiPm1BKv0&feature=player_embedded

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About Sam Ware

I graduated from Penn in 2013, majoring in Health and Societies. I worked at Aravind Eye Care System in Madurai during the summer of 2012. I'm currently serving as a Global Health Fellow in rural Haiti where I manage community health programs for 75,000. I'll be returning to the US at the end of June 2013 where I'm very excited to eat tons of dairy products and green things!