Aravind eye care center an inspiring model

For those unfamiliar with its history, Aravind started 35 years ago because of the vision of one individual, Dr. G. Venkataswamy (known as "Dr. V"). The original staff included several other family members, and the family continues to supervise Aravind today. The organization has grown from part of a house in Madurai to a separate hospital to a statewide network of hospitals.

Most American ophthalmologists know Aravind for its service for indigent patients. Each year, Aravind conducts hundreds of camps, and patients who require cataract surgery are immediately transported to the hospital for surgery the next day. Their two-night admission is completely free, and Aravind achieves outstanding results.¹ However, what I observed was not a charity hospital, it was an integrated health-care system.

Aravind also has a large residency and fellowship training program, and it handles an incredible volume of patients-about 2.5 million patient visits and 300,000 surgeries a year. I had the opportunity to do both extracapsular cataract surgery as well as small-incision surgery, which Aravind has helped develop and popularize.²

As someone with a law degree and an interest in health-care policy and delivery, I had read about and studied the Aravind system. Dr. V modeled his hospital after McDonald's, with the idea that reproducibility and efficiency would allow greater throughput.

The efficiency and the dedication of the staff are astounding. Aravind depends heavily on the "sisters," who are young women from the area who enter into a 5-year training program and staff the operating room (OR), make clinic run smoothly, take care of patients, run the camps, cook and clean, and are unbelievably skilled, hard-working, dedicated, and polite.

The OR runs incredibly efficiently, with patients being prepped on one table as the surgeon operates on another. There are four assistants for each surgeon, and the OR staff is experienced and attentive. They are also not afraid to tell you that "your suturing is bad" and "I will see you in the practice lab this afternoon."

The skill level of the surgeons is remarkable. They routinely do difficult surgeries in less than 5 minutes, including cases of brunescent cataracts, weak zonules, and miotic pupils. Aravind's training programs help them identify the most talented surgeons, and those surgeons then become even better thanks to the incredible volume of cases.