RDVP Seminar: Pavi Krishnan (10/20/2004)

Pavi Krishnan screened her movie called Infinite Vision, the story of Dr. Venkataswamy and the Aravind Eye Hospital. [See also previous entry from David Green of Project Impact.] Dr. V. discovered that of the 45M people around the world who were blind, some 12M were in India, and most of them were "needlessly blind" (suffered from cataracts or other treatable disease). Moreover, the blindness was essentially a fatal disease, with people living just 2.5 to 3 years after the onset of blindness. Unable to care for themselves, they were often turned away by other caregivers.

The Aravind Clinic sees 1.4M patients per year, performing some 200,000 surgeries per year, 2/3 of which are done for free. The paying patients cover the costs of the others, and also fund the substantial growth of the hospital chain. All patients, whether they pay or receive free services, get the same high quality health care. The differences are in the accomodations and food provided during the hospital stay. Some 1,500 screening camps bring 600 - 1,000 patients to the hospital per day. By optimizing the process, (and providing support from 4 paramedics per surgeon) the doctors do about 2,000 surgeries per year, versus a national average of 220.

In addition to treating patients, they have started sharing their methods with other hospitals, reaching some 150 hospitals that now average about 5,000 surgeries per year; some reach 10-12,000 a significant factor higher. While the numbers are one piece of it, success also requiers a strong work ethic and culture established by the hospital's leadership. They also work with Aurolab, a non-profit manufacturer of Intraocular lenses (started in 1992) which has cut the cost of lenses from $200 to $5, and is exporting them to 85 countries.

Dr. V's family has been tremendously commited to the goals, with some 40 members of the family in 3 generations being involved. Pavi (the eldest of the 3rd generation) recalls weekly family meetings where children were required to make presentations to their elders. The film also showed the important role that spirtuality played in Dr. V's life.

Pavi readily admitted that this method was well suited to cataracts, and perhaps less so to thinks like pediatrics or cardiology, because cataracts inflicts people across the economic spectrum, so there is a segment of wealthier patients that can subsidize the poorer ones. Plus, cataracts requires almost no followup: after surgery, people are better. In contrast the patients suffering from diabetic complications do require more ongoing maintenance.

Turnover is high among both the surgeons and paramedics. For the surgeons, Aravind is an excellent training ground that gives them the skill to open a private practice. Consequently, the tenure is only about 4 or 5 years. The paramedics are girls age 18-22 drawn from villages at the rate of 500-600 per year. They go through a 2 year training process, live in a hostel setting in the hospital with enforced savings plans. They are selected for their willingness to work hard, discipline and family values. They typically leave after marriage.

Asked about current challenges, Pavi cited retention, scaling, and training, as well as passing the values on to the third generation (with the unstated fact that at 86, Dr. V. will not be around to provide the overall vision forever.)