Aravind Declares War on Cataracts

Actually, Aravind declared war on cataracts a long time ago. For those of you who don't know, cataracts are merely an opacification of the crystalline lens of the eye. There are a bunch of reasons why people get cataracts and excessive UV exposure is one of that. I don't know if you've looked at a map lately, but Madurai is mighty close to the equator and much of the industry around here is agriculture. Therefore, Aravind sees a LOT of cataract cases.

Fortunately, the cure for cataracts is easy. All you need to do is take out the cloudy lens and replace it with an artificial intraocular lens (IOL). We are very good at making IOLs; indeed, we have even created some multifocal IOLS. Cataract surgery is one of most immediately gratifying surgeries we can do. A patient can go from barely making out hand motions to having almost perfect vision through a 10 minute procedure.

The Aravind model for health care delivery should really be called the "Aravind model for doing a crap-ton of cataract surgeries quickly and inexpensively." Today, I spent some time in the operating theatre (OT. Silly British corrupting everything. Will someone hand me a torch? Cheerio.) at the free hospital watching a surgeon perform cataract surgeries. The surgeon was responsible for two tables side by side. While he was taking out one cataract, a patient was set up on the other table. As soon as was finished with his cataract, he'd swing the operating scope over to the next table and do the surgery without saying a word. There was a video camera attached to the scope so I (and the patients in the OT waiting to be operated on) could see a zoomed-in view of the eye and watch the operation in real-time.

Here comes the efficiency: the surgeon was using an older technique than is typically used in the US (he'd take the lens out of one incision, whole, instead of breaking it up with an ultrasound applicator, suctioning it out, and putting a foldable lens in) does the procedure in 5-8 minutes (I timed him). Because they're using an older technique, they can use cheaper equipment and (generic, made by Aurolab) lenses. Also, because the surgeon is working two beds, he doesn't have to wait for patients to be set up. For that matter, he doesn't even take the time to talk to them in between procedures. What I found surprising--and that doesn't increase their complication rates--is that the surgeon doesn't even bother changing gloves in between procedures; he just pours chlorhexidine on his hands in between patients and keeps on going. In the 45 minutes I was in the operating room, I saw the surgeon do seven cataracts start-to-finish.

In the US, we're not this efficient. Most ophthalmologists do maybe 2-3 cataracts an hour (pesky changing of gloves, talking to patients and each patient getting his or her own OR). Honestly, we don't have a reason to be efficient because there just aren't that many people (relative to the number of ophthalmologists in the US) who need cataract surgery.

Here, however, the need is enormous. Most of the 350,000 surgeries Aravind did last year were cataracts and they still haven't made an appreciable dent in the number of people with cataracts in southern India. There is a reason that Aravind does dozens of camps every week and sends busses full of people to the hospital for (free) surgeries from each of those camps. Aravind is planning to open two new hospitals in the next year because the need is so great. For the foreseeable future, the Aravind model will be necessary to treat cataracts if they hope make any appreciable dent in the number of people who are living with poor or no vision.