“Go with the flow.” That was the advice I was given prior to shipping myself halfway around the world to the Aravind Eye Hospital in Madurai, India. My first question at Aravind was “Where is the flow?” The hospital was like a river basin where all of the “flow” made its way to settle in a pool and come to a rest. I thought this as I squeezed through lines of people standing to register for an appointment and walked past teams of families sitting in waiting areas. Some patients were too busy holding their place in their flow to notice a lanky Caucasian guy walk past, but many others studied me silently as I passed.
We were being given a tour of the hospital’s Out Patient Block. Soon enough, however, I was already lost. I recall my 6th grade project to model a cell as an object; I chose a factory as my model. In actuality I should have chosen an Aravind Eye Hospital. Different floors subdivided different divisions of eye disease which were further split into vesicles of patient counseling, refractory testing, prescription distribution, and laser eye surgery. Large monitors bounced registry information back and forth and young women technicians kindly ushered placated patients up and down corridors to where they needed to be. The hospital was an organism with many moving parts, each self-sufficient but also interdependent. But not all parts moved as shown by the motionless waiting rooms. There was a juxtaposition of action as those who were needed worked tirelessly and constantly and those waiting to be needed were motionless but ready.
I began to see the flow and it had me on edge. Aravind was dedicated to ending needless blindness through high quality care. It took as many patients as possible, regardless of background, to give them the greatest gift possible, their sight. In their mission Aravind was a teacup filling itself, and the kettle was all of India. The hospital balanced precariously on the very edge of perfection to keep the cup perfectly filled as the flow added was compensated by cost-cutting efficiency to keep the same flow going out. I watched a doctor suction the nucleus of a cataract lens out of a patient, insert a foldable new lens, prep the patient to leave, then turn to an adjacent bed for another waiting patient for the same procedure. He did this all day.
We shortly received our projects: conceptually easy tasks. Mine was to revamp a resource website, “Vision2020 e-Resource”. It is a database of management techniques that Aravind has amassed over the years. The hope is that no other hospital need face the same development challenges Aravind faced or, “remake the wheel” so to speak. Nearly everything is archived, from structuring a large tertiary care hospital like the one I toured, to planning outreach programs for surrounding villages. All I have to do is make the website easier to use. However, I soon realized that even the smallest changes to the website would have me climbing through layers of time-consuming tasks. I will have to spend time on the website to determine its deficiencies, present them to other consultants, restructure the page, inform the Information Technology Team of the needed changes, quality check the implementations, then develop a long-term protocol for maintaining the website.
The way they manage work flow is different here. All consultants dedicate themselves to their jobs from Monday to Saturday. For me meeting other consultants is difficult because each is performing their specific task for Aravind. They’re often occupied completing another assignment or off at a conference, caught up in their own flow. Under these conditions it is a challenge to begin the long train of tasks that I must complete by the end of the summer. There are often times when I get stuck sitting at my desk, waiting for the next assignment, because all the people I was meant to meet were indispensable. It is times like these where I remember the flow, the different pace that India follows, and the specific task each person is assigned. I’m reminded of the many moving and non-moving parts in this organism and of the small role I play in this massive cell.