•As of 1992: Total 32 billion blind people in the world out of which 20 million are in Asia. India also had 20 million blind people out of which only 12 million were classified as blind. •Major cause of blindness being cataract esp. In developing countries accounting for nearly 75% of all cases in Asia. 80% of cataracts are age related (starts with 45 years and increases dramatically after 65 years of age) Cataract as a major cause of blindness Cataract removal is a routine operation with a 95% chance of success.
Two techniques used: 1. Intracapsular surgery without intraocular lens (ICCE) •Most widely used •Performed without an operating microscope & uses simple instruments •Can be completed within 20 minutes •Eyeball returns to the original shape only after 3-5 weeks •After this the patient is fitted with aphakic spectacles or thick lenses what improve vision 2. Extracapsular surgery with intraocular lens (ECCE) •Always performed under an operating microscope •Requires close to 30 minutes.
•Patients do not require corrective spectacles to restore vision •Quality of restored sight is near natural & free of distortion •Patients usually experience significant improvement in sight within days of operation Note: About 30% of cataract surgeries in India performed by government sector free of cost, 40% of cataract surgeries were performed by private sector for a fee, 30% performed free of cost by volunteer groups & NGOs. 70% of the Indian population was below poverty line. Also, India had very less no. of ophthalmologists (only 8000).
1970 – 20 bed Aravind Eye hospital opened which performed all typed of eye surgery at a reasonable cost. Three people involved were Dr. Venkataswamy, Dr. Nam (brother in law) & Dr. Natchiar (his sister) 1977 – 30 bed annex opened for patients convalescing after surgery 1978 – 70 bed free hospital opened 1981 – Main hospital with 250 beds commences. It has 4 major operation theatres & 1 minor for septic care. Speciality clinics in areas of retina & vitreous diseases, cornea, glaucoma etc. All heads were family members of Dr. Venkataswamy. 1984 – 350 bed free hospital opened.
Hospital had 2 major operation theatres & 1 minor for septic cases. Note: Doctors & nurses were in rotation, thereby both paying & non-paying patients received same quality of eye care 1990 – Aravind opens it free hospital to wal-in patients. Prior to that all the patients were attracted from eye camps Location of Arvind hospitals 1. Madurai (724 beds) 2. Theni (100 beds) 3. Tirunelvelli (400 beds) 4. Coimbatore [under construction] (400 beds) Q. 1. How do you evaluate the quality of service at the free hospital and at the paying hospital? Paying Hospitals •ICCE surgery cost – Rs.
500 to 1000 •ECCE surgery cost – Rs. 1500 to 2500 •Different classes of rooms A,B & C for different levels of privacy & facilities and therefore, different price levels •Standardised procedure – Registration; Vision recording; preliminary examination; testing of tension & tear duct function; refraction test; final examination •Patients in the hallway were attended by medical staff •Complicated cases brought to the paying hospital indicating that this was better equipped •240 people hospital staff, 30 doctors, 120 nurses, 60 admin personnel, 30 home-keeping Free Hospitals.
•Not as organised as the main hospitals •Temporary shelter where patients were meant to wait to register •Different lines for 1st time customers & repeat customers •Patient inflow was somewhat crowded •Waiting rooms were significantly poorer than the main hospital •Lot of commotion, people spread themselves against the walls & floor •Operating theatres were also crowded & cramped •Lack of equipment [e. g. only 1 of the operating tables was equipped with a microscope] •Beds were not given. Patients were taken to big rooms which accommodated 20 to 30 people of nearby villages.
•Detailed records kept Eye Camp •Conducted with the help of local community support, with either local business enterprise or social service organisation taking lead role in organizing them •Local sponsors do the publicity within a 25 mile radius 1-3 weeks in advance •Sponsor pays all the direct costs in organising the camp like patient transportation, food etc. This was about Rs. 200 per patient. Aravind bore the cost of surgery & medicines. Reasons for which this had to be done was that people did not go for surgery even after recommendation for the following reasons:
-Still have vision, however diminished -Can’t afford food & transportation -Can’t leave family -Fear of surgery -No one to accompany -Family opposition •Recently there was a conscious effort to move away from surgical camps because of the cost involved as well as lower quality of service provided. For e. g. makeshift theatres were not air-conditioned, cleanliness & hygiene were not up to the hospital standards, patient amenities were inferior, post-operative complications were difficult to monitor •10 member team of camp organizers was in place. They reported to the camp manager.
They worked closely with camp sponsors, helping & guiding them in publicity, organising logistics, arranging physical facilities etc. They were given districts and met once in a week at Madurai under the chairmanship of Dr. Venkataswamy. The response rate of the camp has improved. From 15% earlier, 83% of the people now are taking surgery when advised to do so. Q. 2. What has been the role of Aravind’s clinic & support staff? •The hospital runs because of them •They are the ones performing surgeries & other operations •They are the ones who are organising the eye camps.
•They are the ones who have brought reputation to the hospital •They are the ones who interact with customers all the time Other Details – -Work in low salaries and therefore the low cost model can be sustained. -They work double and continuously. 60hrs work done per week when compared to 30 hrs in pvt sector. For e. g. his sister joined at half the salary she was getting at govt. It is because of this that the no. of staff required is less and there is low cost. -Nurses work at dirt cheap rates i. e. only 12ooo per year -Selfless service of staff -Capable, intelligent, trained in theoretical knowledge.
-Very efficient staff -5 work days in hospital… Saturday, Sunday on camps. Therefore, work on all 7 days. Q. 3. Are there any weaknesses in the Aravind’s model of delivering eye care? •No branding of camps. Camps were always promoted under sponsors names. •They are too early to come up with a free hospital in areas where their main hospitals are not profitable. They are not conducting proper analysis or feasibility studies before entering new markets. •Present in only one state of Tamil Nadu and small presence in Kerela through camps. Should expand more and make use of surplus funds.
•The free hospitals should not be getting the best doctors. The best doctors should be engaged in service in the main hospital only. This would save costs. •For the free hospitals funding can be done from external sources and it should try to expand in other parts of India with the funds it makes from the main hospital. •There’s a lot of dependence on Madurai. For every small district entered, the hospital should also enter a profitable city where people will be willing to pay for Aravind’s services. •A challenge is to transfer the demand from Mon, tues, wed to Thursday, Friday.