In India, there is a model for healthcare that goes against all economic logic. People pay what they can to have their sight restored. If they can’t pay, they still get the gift of sight. No bank was prepared to back Dr Govindappa Venkattaswamy, yet today the results of his service are felt in 30 countries across the globe.
I pay R7 to have an eye test. I can come two more times in the next three months and I will not be charged. I first do a glaucoma test, then I am tested for vision, and then examined for uveitis, an eye disease I suffered in my youth. I am given a clean bill of health.
The hospital is spanking clean. Every day it sees 1,200 patients and the doctors perform over 200 operations. But this is only the beginning of an amazing story. It is part of a network of eye hospitals that has seen 32 million patients over 36 years and performed more than 4 million eye surgeries, most of them ultra-subsidised or free.
All this originates with the vision of one man, Dr Govindappa Venkataswamy, affectionately known as Dr V. In 1976 he founded Aravind as a post-retirement project when he was 58. He was inspired by one of India’s legendary philosophers, Sri Aurobindo, whose reflections on the transience of humankind influenced many thinkers. He spoke to the prerequisite for a collective and radical transformation of consciousness of the human spirit.
Dr V represents that ascent of the revolutionary staircase that unites the inner soul and the logic of nature. He set his goal to give the right to sight to the 12 million people in India suffering from preventable blindness. No bank wanted to lend him money. “’You are too old, they said. You are prepared to operate for free on patients who cannot pay. You don’t have a business model we can fund.‘”
So he mortgaged his family jewels and created the first 12-bed hospital in Madurai in the south of India, one of the country’s oldest cities and home to the famed Meenakshi Amman temple, dating back to 6BC. Here the patient has the choice to decide whether to pay or not. In a country where a huge majority of people live on less than $2 a day, he ripped off the price tag for access to world class quality eye care.
Then he decided he would never ask for a loan again. Aravind would run as a Trust that controlled the operations and the surpluses would be used for more operations. Today there are seven major Aravind Hospitals, over 50 vision care centres and they consult and work with eye hospitals in over 30 countries.
As my son and I walk through the hospital, we are amazed at the energy that resides within. It is a railway station. But there is an air of serenity. It is spotless but I do not see a single cleaner. I ask the outreach manager, a young beautiful woman called Priya, how they manage such an efficient operation and yet remain so calm. She laughs.
“We love our work here. Dr V had a vision – ‘To see all as one; to give sight to all.’ We believe that vision.”
I understand. It spans a beautiful rainbow arc that unites a revolutionary business model with a profound compassion of our shared humanity.
How sadly lacking are we today, globally and locally, of selfless leaders such as Dr V. His goal was “to spread the Aravind model to every nook and corner of India, Asia and Africa; wherever there is blindness we want to offer hope. Tell me, what is this concept of franchising? Can’t we do what McDonald’s and Burger King have done?’
The only difference I would add is that Aravind is delivering high-quality health rather than junk fast food.
Today the Aravind Eye Care System is the largest provider of eye surgeries in the world. They see more than three million patients and perform over 300,000 surgeries a year. That is almost 7% of the global total. And their record of proficiency is better than that of the UK healthcare system.
The simple philosophy is to create awareness that blindness is largely preventable, building trust that Aravind will deliver world class treatment even if it is free and ensuring access to the most remote communities through the outreach camps, underpinned with the values of humility, compassion and service.
I ask Mr Poobalan from the hospital administration in Pondicherry how he can run such a fantastic facility and achieve so much.
“We have commoditised our operations. Everyone knows exactly what they have to do. The clinical staff must do the diagnosis. We have the most sophisticated equipment here. The doctors must prescribe and operate. The counsellor staff must explain all the procedures to the patient. The administration must work like clockwork. There is no laziness here. Staff that do not have the work ethic of Aravind do not stay long. For us the patient is the focus of everything we represent.”
I think back to our healthcare system in South Africa. I know that we have islands of excellence that match this, but the norm is that the system is designed more to serve the interests of bureaucrats, politicians and staff than the patient.
My son asks Priya how they manage to ensure efficiency. She takes me to the data clerks outside each major section of the hospital. They have a real-time system. It monitors the waiting time in each unit of those waiting versus those seen. At any time staff can be allocated instantly to where they are needed.
I ask what the average costs will be if a patient requires complicated eyed surgery such as a cornea transplant. Dr Veena, a senior surgeon, replies: “The average cost for the most complex surgeries will vary between R1,600 and R3,000. It will cover all the tests, the cost of the operation, the hospital accommodation and medicines. The patient will have to pay separately for food. And if you cannot pay it will be free. You will get exactly the same operation and treatment but accommodation will be in general wards”
We are stunned. Why can’t this be the model across the world for all our healthcare needs? I ask what the costs of spectacles are, knowing that we pay hundreds of rands for them in SA. On average a set of quality spectacles costs on average R50 at Aravind.
The only variable is volume and the efficiency of the system. But even then I know that the real reason in SA is a monopoly that drives up the costs that puts profits before the patient.
As we debate the future of our healthcare system and the proposed National Health Insurance, I ask myself how these ethical human values can be integrated into the way our health system works.Throwing money at our problems is not going help. I know that at Aravind every member of staff will bring their children to this hospital because they trust the quality of healthcare they are delivering to the patients who flood their gates every morning.
They have their heart in their work. It gives them meaning in their lives. They are here to serve and they do that from a deep-seated feeling that we are all born equal and united by the human spirit. It’s more than the salary package. It’s about service with passion and an infinite vision. DM
For more information, go to Aravind.
And see documentary on Dr V – Infinite Vision.
Also Sri Aurobindo Society.
Stephen Hawking held a party for time travellers. He sent the invitation out the day after. Nobody attended.