For an estimated 45 million people worldwide, and nine million in India, the precious gift of sight has been snatched away, most often quite needlessly. One man, seized with a passion to eradicate needless blindness, decided to do something about it.

In 1976, Padmashree Dr. G. Venkataswamy, popularly referred to as Dr. V, retired from the Government Medical College, Madurai, as the head of the Department of Ophthalmology. Rather than settling for a quiet retired life, Dr. V was determined to continue the work he was doing at the Government Medical College, especially organizing rural eye camps to check sight, prescribe needed corrective glasses, do cataract and other surgeries as needed, and advise corrective and preventive measures: in short, provide quality eye care. This was to be provided to the poor and the rich alike. His vision was simple yet grand: eradicate needless blindness at least in Tamil Nadu, his home state, if not in the entire India.

Dr. V. started a modest hospital with his personal savings and with partial government support^[1] for cataract surgeries done on poor patients from eye camps. From the beginning, a policy was put in place—there would be paying as well as free patients. The paying patients would be charged only moderately and not more than comparable hospitals in the city charged. There were to be no “five-star” customers to cross-subsidize the poor patients. Dr. V was certain that high productivity and volumes were necessary if the hospital were to be viable and generate a surplus to provide expansion funds.

Indeed, the hospital generated a surplus from the very beginning, and using such surplus it was possible to open a 30-bed hospital within a year, in 1977. A 70-bed hospital meant exclusively for free patients was built in 1978. The existing paying hospital building was opened in 1981, with 250 beds and 80,000 square feet of space over five floors. The initial focus was on cataract surgery, but other specialties such as retina, cornea, glaucoma, pediatric ophthalmology, neuro-ophthalmology, uvea, low vision, and orbit were gradually added. No compromises were ever made on the equipment; they were of the best quality, and many were imported. However, the rooms (including those of doctors), waiting halls, and examination rooms were utilitarian. In 1984, a new 350-bed free hospital was opened to cater exclusively to free patients in Madurai. In stages, the number of beds increased to the present 1,468 beds (1,200 free and 268 paying) in the hospitals in Madurai.

In addition, other hospitals in other towns in Tamil Nadu were being opened. In 1985, a 100-bed hospital at Theni, a small town 80 kilometers west of Madurai, was opened, mainly to cater to additional eye camp patients. A hospital with 400 beds was opened at Tirunelveli, a town 160 kilometers south of Madurai, in 1988. In 1997, an 874-bed hospital was opened in Coimbatore, the second-largest city of Tamil Nadu, to cater to the needs of the population in that area. In 2003, a 750-bed hospital was opened in Pondicherry (a Union Territory but within the geographical area of Tamil Nadu) to cater to the people living in northern Tamil Nadu. In total, the five Aravind Eye Hospitals (AEH) had 3,649 beds, consisting of 2,850 free and 799 paying beds.

Though the initial focus was on building hospitals and reaching out to the poor to do cataract surgeries, it was soon clear to Dr. V that to reach their goal of eradicating needless blindness, several other activities had to be put in place. Thus, over the years, these activities were added, and Aravind Eye Hospitals evolved into the Aravind Eye Care System, with its many divisions: Aurolab, the manufacturing facility set up primarily for manufacturing intraocular lenses; a training center named Lions Aravind Institute of Community Ophthalmology (LAICO); a center for ophthalmic research named Aravind Medical Research Foundation; a research center for women and children named Aravind Centre for Women, Children and Community Health; and an international eye bank named the Rotary Aravind International Eye Bank. All the activities of these divisions relate to the core mission of eradicating needless blindness.

Eye camps represented a popular way to reach out to rural communities. These camps were formed in different villages, with prior publicity in the form of posters, loudspeaker announcements from vehicles, and pamphlets. Charitable trusts or individuals sponsored the eye camps and contributed to the publicity necessary to get people to the camps. The government and institutions such as the World Bank covered the costs of surgery and treatment. The eye camp checkups and subsequent treatment were free for the patients. On the day of an eye camp, patients were examined, and those requiring surgery were advised of such. In some camps, surgeries were done in situ in makeshift tents. AEH believed this was neither hygienic nor productive and so it performed the surgeries only in its base hospitals. Follow-up checks and prescriptions for glasses were made in subsequent camps or during patients’ visits to hospitals.

The cost (for a sponsor) of an eye camp varies with the nature of the camp. A “small” camp with 300 outpatients (leading to about 60 patients for surgery) costs about 6,700 rupees, whereas a large camp, with 1,000 outpatients and 200 surgeries, can cost up to 42,500 rupees. Finding sponsors is not a problem. Generally, local NGOs, Lions and Rotary clubs, local industrialists, and businessmen and philanthropists sponsor the camps. Sponsors also cover publicity expenses (posters, pamphlets, banners, megaphone announcements from vehicles, and so on) and expenses related to the organization of the camps (usually in a school or public place).

Other community outreach programs include a diabetic retinopathy management project that at eye camps screens nearly 12,000 people per year, a community-based rehabilitation project supported by Sight Savers International that is aimed at rehabilitating incurably blind persons through community-based support, and an eye screening of school children that helps train teachers to detect eye defects so corrective measures can be taken early. (In 2002, for instance, 68,528 children in 80 schools were screened and 3,075 given glasses to correct refractive errors.) The Aravind Medical Research Foundation coordinates ongoing research, such as clinical, population-based studies and social and health systems research conducted using the data readily available in the hospitals and the community outreach programs.

Despite having a majority of patients as free patients, the Aravind Eye Care System has always been financially self-supporting. Even from the beginning, it did not depend on government grants or donations (except for the support given by the government toward eye camp patients), and until recently it had not applied for any other government grants for service delivery. Dr. V, now in his 80s, stresses the point that not only is the Aravind Eye Care System self-sufficient in terms of operational income and expenditure, but it also takes care of capital expenditure for all expansion and new units. Said Dr. V: “You management people will tell me, why don’t you go to the banks, take loans and grow faster? Cost of debt is low. But we, as a policy, will not go to the banks for loans, since it will compromise our freedom.” Each new hospital is not built until enough surplus has accumulated.

Aravind Eye Care System’s purchase of the best equipment available includes an IT system that tracks all patients, regulates workloads, and closely monitors postoperative complication rates. The contrasting utilitarian rooms for doctors and staff confirm that the emphasis is placed on quality care for patients. Doctors and staff work longer and harder than in other health-care programs, in large part driven by the spirit of Dr. V’s original commitment. The dedication of the earliest doctors and staff of the system extends itself with training and recruitment programs, among which is the Aravind Eye Hospital (AEH) & Post Graduate Institute of Ophthalmology, initiated in 1982, which had admitted around 30 resident doctors as of 2003. All admissions are based strictly on merit, and no admission or capitation fee are collected; the going rate in 2003 at other private teaching hospitals was about 1.5 to 2 million rupees.

Doctors are crucial at AEH, and most were recruited as residents. A doctor explained, “We do commit ourselves totally to the cause of eradication of avoidable blindness. That means we have to do a certain number of surgeries every day. (Each doctor does about 2,600 surgeries per year; the all-India average is about 400.) We have a unique culture based on service. All the doctors speak softly to patients and nurses. No shouting here. If a doctor behaves in an unacceptable manner, word goes around the hospital in no time, and the doctor will be in trouble. We believe in mutual respect as a core value.” The system also recruits and trains its own ophthalmic assistants (900 on staff each year, and 99 percent of those trained stay in the system). Nurses, like the doctors, are there because they want to be. As one nurse said, “I work more than the government hospital nurses do; I get paid a little less or at par with them, but I get much more respect in the society. When I go in the bus, someone will recognize that I work in AEH and offer me a seat or be nice to me. I really feel happy about it.” The staff strength of the Aravind Eye Hospital, Madurai, as of February 2003, was 762. For about 113 doctors, there were 307 nurses, 38 counselors, and 304 other staff. The pattern of staffing in other units is broadly similar.

The driving culture of the Aravind Eye Care System is that of giving as much time and effort as they can toward the organizational mission of reducing needless blindness. Dr. V’s leadership style is that of “leading by doing.” Dr. V and other top staff pick up pieces of paper lying on the hospital floor and hand them over to the next sweeper they see. They do not shout or get upset with the sweeper but by their action demonstrate the value of cleanliness and humility. Dr. V has reason to be pleased with his achievements, but he looks to the future beyond the Aravind Eye Hospitals with the urge to develop other sustainable systems that better utilize doctors and heighten their productivity. Despite all their efforts, only about seven percent of the target population comes to the camps, and he hopes to increase that percentage. Also, he hopes to improve the skills of all doctors who perform eye surgeries, which will reduce recuperation time and increase the subsequent ability of patients to earn a living. Even better postoperative care and counseling are part of his ongoing efforts to ever improve the vision of everyone, while in his small way he spends every day making a difference.