the eye and Madurai

I spent an entire day at the Aravind Eye Hospital, founded by Dr. Venkataswamy thirty years ago, and which many say is the second great temple in Madurai. In the book From Here to Nirvana, which is a Lonely Planet kind of guide to ashrams and temples, the Aravind Hospital is one prominent destination. The first great temple, of course, is the temple of Meenakshi, the goddess with the fish-shaped eye, first built 2500 years ago and last rebuilt four centuries back. I spent the evening at the Meenakshi Temple, bemoaning that I’d only an hour to experience its splendor. But these notes are regarding Aravind.

Madurai MeenakshiI stayed at Aravind's International Students Hostel, and met at breakfast the other inmates. They were management students from America doing a 10-day assignment at Aravind. Two among them were Indians, man and woman, and spoke with the born-in-America accent. I asked the young lady about her school: “We’re from a school called Wharton,” she said. “It’s in Philadelphia. Have you been in the US?” I was last in Philadelphia in September, and every time I crossed the river I had stared at it in disbelief, that all these wealthy people and mighty establishments have left so much water still flowing in it.

The river of Madurai is Vaigai, and on the day I was there it was only a long wide bed of sand indifferent to the thin stream on it that hardly flowed. My companion assured me the water runs below the surface. He was being kind to the city, for, though the water is gone from their river, the good graces of the people overflow, which we saw everywhere: on the street, in the shops, on the restauranteur’s face, in the hostel, and most of all, in all whom we met at Aravind.

Dr. VenkataswamyDr. V founded the hospital when he was 58, a clinic with only eleven beds. Now his hospitals are in six cities, and have hundreds of beds, and on the day of my visit they were treating 1600 patients in Madurai alone, and none of the patients had arrived with an appointment. No one takes an appointment; the poor don’t know such a thing. But the IT systems at Aravind can tell how many may check-in based on past data and the time of the year (holidays, school terms, festivals, the weather of the season). The forecast for the day was 1560. The patients may choose the paid service, or the free service, and in either case they receive first-rate treatment. Dr. V started the hospital on that premise: “I’ll first give you the best eye care. Pay me what you can. If you can’t, it is okay—pay me later.”

He employed a proven method to secure profits, the McDonalds method to mass-produce in multiple locations without loss of quality. Aravind’s strength is excellence is ophthalmology, combined with systems for mass delivery—in multiple locations—of diagnosis and treatment. They charge very less; two-thirds of those treated do not (cannot) pay; and in this manner of the charitable organization Aravind still makes enough money to pay the bills and invest for growth.

There is just enough room in each area of the hospital. No space is wasted. Each floor was built in answer to demand, and when money became available. On the computer terminals in every section the focus is always the same, to treat as many as possible as quickly as possible and to free the resources to take in even more. Every section can see on its screen how it is faring against the others. The focus serves both sides well: the patients need to go home quickly; the hospital needs to attend to everyone who came.

The Aravind Eye HospitalAnd they don’t wish for less to come. They go out into the villages and fetch as many patients as they can find. Their mission, after all, is complete eradication of needless blindness, and 12 million Indians are blind this way, against the world’s 45 million. And they’ve improved this process every year. First they brought patients by bus and did the diagnosis and the treatment in the hospital. Now they perform diagnosis in the field using a satellite link to the hospital, and screen patients on the spot to determine who needs to come to the hospital, and who should be dealt with right away. In separate strategy-sessions they are generating new ideas so as to innovate and reach even more numbers.

Aravind has performed the most number of eye surgeries in the world.

Dr. V saw more opportunities to reduce cost and make eye care affordable for every one. The IOL, for instance: That invention, made in the west, was a great gift to humanity, but costing $200 (rupees 9400), it served only a portion of those who needed it. He asked: That lens looks no different than a shirt-button; why should it cost any more than ten rupees?

Aurolabs, MaduraiAravind established Aurolabs—a technology-development and manufacturing extension—to give substance to that question. They make affordable lenses that Aravind uses, and also export them to 80 countries. Besides the highly inexpensive rigid lenses, they also make foldable lenses for those who can afford them, but still at a lower cost. They’ve emerged a good manufacturer, and extended the range to produce surgical needles, and eyedrops, especially those too expensive outside, and drugs orphaned through being abandoned by pharmaceutical majors.

The man who gave body to Dr. V’s vision is his brother, Srinivasan, who doesn’t credit himself for anything. He says Dr. V had a way of asking for more: “As you were saying,” Dr. V would tell Srinivasan who’d never said any such thing, “I think we should build a hospital in a new place.” Today, Srinivasan’s son Aravind is the administrator for the group. Aravind is himself an ophthalmologist, and a management graduate who has studied under C.H. Prahalad in America. An astonishing number of family members of Dr. V are the management (and doctors and administrators) of the hospital, and a transition from the old to the young seems to be in progress.

I told Aravind, after the visit to Aurolabs, that I was moved by what I saw and began to explain, but he cut in to emphasize that Dr. V’s vision was in his own realm. Alarmed, I cut back in, and corrected myself, saying I was in Aravind to seek opportunities in Medical Electronics to diversify my own business. He was relieved, that I wasn’t going to begin a sentimental journey, and moved his hands quickly on the keyboard and the mouse, and pulled down possibilities, and mailed them to me the instant I asked for them. A young assistant interrupted us; she had a question for Dr. Aravind; but she was in a fluster for words; after she left I asked him his age—forty; but I’d supposed he was no more than thirty.

I hope I’ve made a friend of him. He was so affable, and so helpful, and so willing to partner.

Madurai Meenakshi Temple------------------------------------------------------------------------------
The picture at bottom is mine. Photos of Aravind Eye Hospital from their website, and of Madurai Meenakshi from Wikipedia.