India has a population totaling over 1 billion people and accounts for 16% of the world's population.  Over 12 million people are partially or completely blind and of this number, it is estimated that over 60% is reversible blindness caused by cataracts.  The highest rates of blindness are in the rural, illiterate, elderly population.  My visit to India was to an institution in Madurai, Tamil Nadu that is single-handedly making an enormous impact in the fight against blindness in India.  One of every 20 cataract surgeries performed in India is performed at this institution.

Aravind Eye Hospital

The Aravind Eye Care System was founded in 1976 by Dr. Venkataswamy, who was at the time a 58 year old ophthalmologist suffering from rheumatoid arthritis. Sri Aurobindo, after whom the hospital system is named, had a deep spiritual influence on Dr. Venkataswamy; Sri Aurobindo taught that transcendence to a higher state of consciousness could occur through service.  Opened initially as a single 11-bed hospital with the goal of eliminating needless blindness, the Aravind Eye Care System has now grown substantially with four other branches throughout southern India totaling over 3,500 beds.  It is now the world's largest eye care provider and recorded over 250,000 surgeries and 1.7 million outpatient visits in the last year.  Approximately two-thirds of the care is provided free of charge!  One patient that can pay does so for two that cannot.  Costs are also kept low by vertical integration through manufacturing sutures, pharmaceuticals, blades, and intraocular lenses in-house through the Aravind subsidiary named Aurolab.  The costs of certain products have been brought down by over 95% making them more affordable for not only the rural Indian population but for other developing countries as well. 

Dr. Samir Shah operating

Socioeconomic differences between American and Indian populations encourage the development of creative and cost-efficient surgical techniques.  High-tech ultrasound machines are routinely used to remove cataracts through a 3 mm incision in a process called phacoemulsification in the United States.  Though this is available in India, the costs are prohibitive for the vast majority of the population.  The Aravind Eye Care System is able to provide comparable results in visual improvement by substituting expensive technology with impressive manual dexterity and surgical skill.  Well-constructed, self-sealing surgical wounds combined with unique instruments and gentle ocular manipulation are used to remove cataracts in a technique termed small-incision extracapsular cataract surgery.  With the generous support of the AAPI-MSRF scholarship grant, I was able to visit India to learn this technique.  It is rare for a graduate of an American training program to even be exposed to this skill. 

My day would consist of visiting the operating room in the morning.  It would begin with observation of the senior surgeons performing phacoemulsification as well as extracapsular cataract surgery.  Multiple patients would be prepped for surgery in one operating room. Between cases, the surgeon would use a chlorhexidine rinse over his or her gloves instead of rescrubbing, regowning, and changing gloves.  Turnover time was basically non-existent.  It would not be uncommon for the surgeon to perform up to 60 surgeries in one day! In the late mornings, I would begin my one to two surgeries under the supervision of a trainer.  The afternoons were spent mostly in the Cornea clinic seeing patients side by side with the faculty and fellows.   The pathology is more severe than what we see in the American clinics as the patients usually do not present to a doctor until the vision impairment has significantly affected their daily functional ability.  The evenings would consist of postoperative examinations of the patients that were operated on earlier that morning.  My typical workweek would consist of a similar routine from Monday through Saturday.  I spent my free Sundays visiting nearby sights including Kodaikanal, Kanyakumari, and Padmanabhapuram.  Over my time there, I personally performed 20 surgeries, observed hundreds, evaluated several interesting patients in clinic, and lectured to the residents and trainees.

To know that a system of such efficiency exists in a third world country is comforting for those that have been served and hope for millions of patients that will one day be served.  For those who train and visit there, it provides great inspiration to see what can be achieved with dedication and resolve.  It is the goal of the Aravind Eye Care System to expand throughout and beyond India.  One man's dream has become humanity's vision and provided this young physician a memorable life experience.