Rehab

I'm sorry it's been so long since I've posted. Things have been pretty busy here. Since my post, the rest of the Dartmouth crew has left for the Great White North (a.k.a. Hanover) and a new set of people have arrived: Four MBA students from U Michigan (evaluating a project which I'll address in a minute), an ophthalmologist (retina specialist) and his wife from FL, and a retired logistics manager from Fedex, his wife and daughter (NP who does heme/onc) from Boulder, CO.

The Fedex logistics manager is going to work for Aravind and help them more efficiently deliver care. He's here for a month with his family picking out more permanent living arrangements and he and his wife will return to Aravind in June for six months. Basically, he's retired and wanted to do some community service and saw Aravind as a place where his joys and talents could meet the world's needs. In a Steve Jobs-esque move, he has offered to work for Aravind for $1 per year.

The ophthalmologist and his wife are originally from India but moved to the US a couple of decades ago. Ironically, she is the only person to have become sick from eating the food here (kids, watch what you eat). They are both very nice and are visiting to see the temples in the area.

Now, let's talk about rehab and senior citizens. India's population is at right around 1.2 billion people right now. According to wikipedia (what other sources are there, really?) approximately 5.3% of the population is over the age of 65. That's about 64 million senior citizens. There is nothing like Medicare or Social Security in India, so in theory the elderly are cared for by their families. Note that I wrote "in theory" because in reality many elderly parents no longer live in the same cities as their children and some senior citizens are childless. Many children also work full time and/or are unable to adequately care for their parents in their homes. Unfortunately many of the elderly are destitute (see: lack of Social Security and Medicare).

Another phenomena (along with having a significant number of older people) that comes along with an improving economy is the presence of chronic diseases. In the developing world, people generally die of acute diseases: You're pretty worried about malaria and polio and cholera, not so much about atherosclorosis and Type II diabetes. In the developed world, we're not so worried about polio and TB but are about strokes, heart disease and diabetes. When you are able to cure the acute diseases, the chronic ones take a much heavier toll on your population (everyone needs to die of something.

Acute diseases are somewhat a problem in India. It's, for instance, one of the six countries in the world where polio is still active. We still see some pretty bad eye infections in the clinic here. But now there are lots of patients here with diabetic retinopathy and hyperthension. People are also living long enough to have heart attacks and strokes (and a large number are living). People are living through spinal cord injuries and amputations. Many of these patients are old. Alzheimer's and dementia are becoming bigger issues. All of these patients need some help (physical therapy, occupational therapy, PM&R (physical medicine and rehabilitation), etc.) but there are few PT services available and almost no PM&R docs.

To solve this problem, one of the ophthalmologists working at Aravind (coincidentally--or not-- named Dr. Aravind) bought a farm a few years ago. This farm is about 30 minutes from Aravind (near Aurolab) and looks like it's in Hawaii. It's peaceful and there are coconut trees (I had my first drinking coconut off of one of those trees), mango trees, a rice paddy, banana plants, a pond. Dr. Aravind has started building a rehab facility there (to US standards). It will be fully staffed with skilled providers (nurses, PTs, OTs, a PM&R physician imported from somewhere). There will be large windows, and wheelchair ramps accessible to outdoor areas.

The rehab facility is desperately needed (as our business students have confirmed with their study). Dr. Aravind is committed to following the Aravind Eye Hospital model of treating two patients for free for every one paying patient. Dr. Aravind is one of the new generation of leaders at the eye hospital (with a M.B.A. from Michigan) and is passionate about this project. He is already planning for the retirement facility he will build on the 40 acres attached to the 30 acre plot the rehab facility is on.

One of the things I've come to appreciate about India is that there is so much potential here, and not just economic potential. In some ways they have caught up to the West but in other ways they're still years behind. They can, however, learn from our mistakes and do things better than we have done (and I would argue that the Aravind Eye Hospital is in many ways something that was built with this knowledge). Dr. Aravind is one of those people who has the capability to shape the India that is still in the process of being created. Both the rehab and retirement communities could be a model for what is possible in India. I honestly believe he is one of the minds of his generation who can help India to become better at rehabilitating its injured and taking care of its elderly than the West has been.

More later...