The Aravind Eye Care System: An Analysis and An Experience
By Swarup Swaminathan, MS2, 2011 India Elective Scholarship Recipient
As a young medical student interested in ophthalmology, I was enamored by the opportunity to conduct a study at the Aravind Eye Hospital. Internationally respected for the number of free surgeries performed and the volume of patients seen, the Aravind institution is a powerhouse of ophthalmology with countless international partnerships spanning the globe. Working with my mentors here in the United States, I was able to craft a unique project focused on studying Aravind’s satellite community centers. With the introduction of surgically-equipped centers, management officials in Aravind were interested in comparing the performance of these centers to the non-surgical centers that have existed for several years.
The design of my study evaluated patients seen in Dindigul, Tamil Nadu, a surgical community center, versus Tirumangalam, Tamil Nadu, a nonsurgical community center. If the doctor recommends a surgery or a referral to a specialty, what percentage of patients comply? How quickly do they do so? If the ophthalmologist recommends glasses, do they purchase them? How empowered do the staff feel at each site? These were some of the questions I was trying to address.
I spent most of my days analyzing data from the electronic medical records or medical charts at the sites themselves. I traveled daily to the sites early in the morning, and reviewed charts, logbooks, and electronic data. Part of my data analysis occurred in the exam room itself due to space limitations. Because of this, I was fortunate to examine patients with unique ocular conditions such as fungal keratitis, complete ophthalmoplegia, and Loa loa filariasis, which are uncommon in the US.
In the evenings, I had dinner with ophthalmologists and optometrists from around the world, including Lebanon, South Africa, Ethiopia, Egypt, and Switzerland. It was fascinating to learn about the variations among ophthalmology practices globally. I was also able to attend grand rounds at the base hospital on a weekly basis, which was a wonderful way to learn more about ophthalmology and interact with the local residents. I was also able to observe several surgeries in the OR, spend time in the subspecialty clinics, and visit the free hospital clinic, all which were incredibly valuable learning opportunities.
My study determined that surprisingly, there was no significant difference between the surgical and non-surgical centers, pointing to mostly financial difficulties as the main hindrance to compliance. However, the study was valuable in identifying certain aspects of operations at the centers that would improve compliance levels, especially spectacle purchase rates. I presented these findings to the management staff at Aravind, who were highly appreciative of the data.
I am extremely grateful to AAPI-MSRF for supporting me in this endeavor and allowing me to gain first-hand experience in ophthalmology. Aside from learning about the mechanics of one of the most expansive health care systems in the world, I gained experience in the realm of hospital operations, which will be an asset to me as future physician in the United States. Ultimately, the time that I spent at Aravind has allowed me to realistically envision my career in ophthalmology.