healthmedicinet

The world’s largest provider of eye care isn’t located in Boston or San Francisco. Situated in the small town of Madurai in southern India, Aravind Eye Hospital performs sixty percent as many eye surgeries as the entire National Health Service of the United Kingdom, with half the complication rate and less than one percent of the cost. Sixty percent of Aravind’s surgeries are free or ultra-subsidized, and it still maintains impressive margins. I had the incredible privilege to spend ten days observing in Madurai last June.

Strolling through the pale blue halls of the hospital, there is no futuristic technology separating Aravind from its competitors. The layout and equipment of the clinic appear ordinary, but the striking difference is the employees. Women dressed in vibrant saris (traditional Indian dress) decisively move through the hospital. Each “sister” holds a distinct role, but a persona appears common. Each sari is precisely tied, hair styled in a tight bun, and no jewelry is worn. More prominent than outward appearance is the confidence and purpose carried by each sister. Walking between wards, everything is controlled by these women. They guide the blind, comfort the families, create the glasses, and monitor patient flow. The physicians diagnose and operate — the nurses do everything else.

But as I read coverage of the Aravind System, every visitor focuses on Aravind’s management strategies. In reality, the unreplicable aspect of Aravind — the reason no other hospital in the world has been able to recreate the system — is the sisters.

So how does Aravind establish such a unique culture? I spoke with Dr. Usha Kim, director of MLOP (mid-level ophthalmic personnel) training, about how Aravind empowers such young women to become the most dedicated hospital employees in the world.

Dr. Usha first explained why all of the nurses are female. Applicants are judged by the qualities innate to Aravind’s model — natural empathy demonstrated through the care of younger siblings, or diligence from helping in the fields. These values are often already developed in girls from Madurai’s rural communities. During the interview, she asks questions like, “how much did you pay for your bus fare?” This is meant to determine if the girl is aware of costs incurred by her family and possesses the humility to empathize with Aravind’s patients.

Aravind’s model is driven by the respect for and connection to the impoverished. The culture is built through modesty, the empathy to understand their patients beyond a diagnosis, and the genuine joy of serving others. All sisters come from poor families in the surrounding villages, and none have any prior experience. Without the opportunity from Aravind, these girls would be working in the fields or be forced to marry. This opportunity truly transforms their lives.

Alees, a veteran sister, described her rise from new recruit to senior leader. She explained how she remains at Aravind because she feels empowered to improve any department. “If a junior member approaches a senior with an idea, it will always be heard,” she explained. “I can ask Usha madam anything… she trusts me.” Aravind maintains transparency and accessibility amongst all management, and because MLOPs are empowered to effect change, they maintain their unparalleled performance.

Aravind also ensures sisters receive recognition for their work and have opportunities to develop professionally. Alees proudly showed me her picture in a textbook and described how she never would’ve had the opportunity to go on an airplane if not for Aravind. The hospital provides funding for MLOPs wanting to get additional certification and has paid for Alees to train in Bangladesh and Egypt.

The longer I stayed at Aravind, the more I was convinced sisters were the driving force of the system. The value they provide, and empowerment they receive is unlike any hospital I have seen, both in India and the US. They are confident and purposeful but maintain humility and compassion. More important than their remarkable technical skills are the values they embody. As Dr. V — founder of the Aravind system — once said, “Intelligence and capability are not enough. There must also be the joy of doing something beautiful.”

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On my last day, I spent time in the free section of the hospital. Glancing through the crowded waiting room, one elderly woman caught my attention. Her eyes were mesmerizing — where the other patients had relatively dark pupils, this woman’s severe cataracts left hers cloudy white.

I scribbled down some notes and looked up to see the woman staring at me. I subconsciously gave my normal response and offered a smile. Generally this elicits a warm reaction, but her face remained blank. It was only after a few moments I realized the impact of her condition. So much emotion is conveyed through sight; this woman was no longer able to experience any of it. Aravind is not only restoring vision, they are restoring life — enabling patients to see, work, and love like they never could before.

So what enables the Aravind Eye System to deliver this world-class care? I asked Dr. Praveen, an ophthalmologist at the Madurai hospital. He responded without hesitation:

“The sisters. They are the backbone of our system.”