Half of India’s ten million blind people could see again if they had cataract surgery. Govindappa Venkataswamy devoted his life to combat this needless suffering. With the help of his family he created a remarkable eye facility that not only treats poor people for free but is a model of compassion and quality. More eye surgeries are performed here than at any other eye hospital in the world.
Dr P Namperumalsamy glares at his computer, his annoyance mounting. Former President APJ Abdul Kalam is to inaugurate a new building of Madurai’s Aravind Eye Care System (AECS) in a couple of weeks, and Namperumalsamy, Aravind’s chairman, is having problems working out Kalam’s schedule. “Dr Kalam is an easy man to satisfy,” the 68-year-old chairman mutters. “But the bureaucrats create all kinds of hurdles.”
Meanwhile, in Berlin for a trade fair, N Vishnu Prasad, 37, the international marketing manager of Aravind’s ophthalmic products, is getting ready to meet his Iranian agent. It promises to be a fruitful get-together – Aravind’s business has been booming in Iran, and there’s a good chance that the government will buy its high-quality intra-ocular lenses.
Around the same time in Madurai, 74-year-old G Srinivasan, Aravind’s finance director, is going through a stack of reports and letters. He spots a cheque for Rs15 lakhs ($33,450), a donation to Aravind from Indian Overseas Bank. State Bank of India has promised Rs40 lakhs ($86,550). Not bad for an organisation that does no fundraising.
In an operation theatre one level above Srinivasan, ophthalmic surgeon N. Venkatesh Prajna, 42, is having problems with a nervous patient. Although Prajna repeatedly tells him to keep his eye still, the man keeps looking around. When the operation is over, A Saravana Kumar, a Madurai ophthalmologist who’s come to the centre to pick up surgical tips from Prajna, compliments him on his finesse.
Later that morning, about 70 kilometres from Madurai, at the Aravind Eye Hospital in Theni, Dr Sathya T Ravilla examines an elderly man’s eyes. Sathya, age 24 and due to get married soon, is a junior doctor at Theni. She’s been there only a couple of weeks, but already feels very much at home.
An ordinary day at Aravind, but there’s nothing ordinary about Aravind. A non-profit organisation with the mission of eradicating needless blindness, it is so efficient that it generates enough money from its paying patients to treat a million poor people, including more than 100,000 afflicted by cataracts, for free every year. Indeed, more eye surgeries are performed at Aravind than at any other eye hospital in the world.
Aravind’s treatment and teaching standards are so high that doctors from around the globe, including from top American medical colleges, regularly go there for training. It has won innumerable accolades, the latest being last year’s $1 million Gates Award for Global Health, the world’s most valuable prize in its genre.
But perhaps the most extraordinary fact about the AECS is that it is the creation of a remarkably tight-knit family (to which the people mentioned above all belong), led for more than three decades by Govindappa “Dr V” Venkataswamy, a charismatic bachelor who was both saint and slave-driver. And although the patriarch passed away several years ago, his legacy continues to flourish, with his grandnephews and grandnieces now committing themselves to the cause.
Dr Venkataswamy had two lifelong passions – his family and his work - and he used each for the benefit of the other. Born into a Telugu-speaking farming family which had been in Tamil Nadu for centuries, he was the eldest of five children. His village didn’t have a school, and the young Venkataswamy learnt to write by spreading sand on the floor and using his fingers to shape characters.
Although his father wanted him to be a lawyer, Dr V studied medicine in Madras. Then, after three of his cousins died during their pregnancies, he decided to specialise in obstetrics. But in 1947, when he was 29, severe arthritis confined him to bed for a year and left his fingers permanently twisted. Indeed, he was never again to be free from pain.
Forced to change specialities, he chose ophthalmology. Those days ophthalmology was considered a minor speciality and Dr V prepared himself for a quiet life prescribing spectacles. But that was not to be. As he went deeper into the field he saw how widespread needless blindness was and began training his gnarled hands to hold scalpels and needles and perform cataract surgery. Within a few years he could stand for a whole day and do more than a hundred operations at a stretch. In 1956 he joined Madurai’s government-run hospital and medical college as head of the ophthalmology department. By the time he retired in 1976, he’d made it one of India’s best.
From 1961, Dr V started organising government-sponsored free cataract surgery eye camps in rural Tamil Nadu. They were so successful that he was awarded a Padma Shri in 1973. His dream after retirement was to establish a base hospital in Madurai with the state government’s help and accelerate the fight against preventable blindness in villages. He was allotted an acre of land, but following a change of government, the order was cancelled.
A deeply spiritual man, Dr V was a devotee of Sri Aurobindo and believed that if you worked in the right spirit, a divine force would empower you to accomplish great things. But now, disheartened, he considered retiring to the sage’s Pondicherry ashram. Within a month, though, he was bored – he needed to keep busy.
But how? Discussing options with his family, he settled on starting an eye clinic in Madurai. It would be run as a business, but quality care would be provided at reasonable rates.
He envisioned a family practice – assisted by one of his sisters, G Natchiar, and her husband, P Namperumalsamy, both experienced eye doctors then in their mid 30s. In addition, there would be Namperumalsamy’s sister, Vijayalakshmi, who’d just finished specialising in ophthalmology, and her husband M Srinivasan who was studying for a diploma in the subject. Actually, Srinivasan, who’d married into the family the previous year, had been keen on anaesthesia, but Dr V had persuaded him to switch.
The clinic would be set up in a house owned by Dr V’s brother, G Srinivasan, an engineer who owned a construction firm. Srinivasan would look after business matters and his wife, Lalitha, would supervise the clinic’s housekeeping.
In fact, when the 11-bed Aravind Eye Clinic – named after Aurobindo – opened in April 1976, Vijayalakshmi was its only full-time doctor.
Drs Natchiar and Namperumal-samy were undergoing specialised training in the US; Dr V still had six months to go before retirement; and Dr Srinivasan had to spend most of his day studying.
Since both Drs V and Srinivasan had to be at the government hospital by 7 am, work at the Aravind clinic began early. “Our morning alarm to get up and get ready was the coffee Dr V’s sister Janaky, who lived next door, sent us at 4.30,” Vijayalakshmi says. “We’d start our first case at 5.15.”
Dr V’s reputation, though, ensured an ever-growing clientele, and within a year a 30-bed annexe had to be built. Meanwhile, several charitable organisations were pleading with Dr V to start free cataract eye camps in rural Tamil Nadu.
Aravind Eye Clinic clearly had to expand. On the advice of a Ramakrishna Mission monk he was close to, Dr V, along with his siblings, formed a charitable trust. Then he, his brother Srinivasan, and both their sisters mortgaged their homes and got a Rs7 lakh loan from the State Bank of India to construct a proper hospital. Rural eye camps began to be organised, and in 1978, a godown belonging to Srinivasan was renovated and poor patients treated for free.
Meanwhile, in the US, Dr Natchiar was having second thoughts about returning to Madurai. “We could have stayed back in the US and made money,” she recalls. But Dr V and she were very close. He had raised her ever since their father had died when she was eight, and as she grew older, she in turn had looked after him. Dr V had nursed her through seven operations to correct a defect in her foot, taught her ophthalmology, arranged her marriage. How could she turn her back on him? She and her husband, Dr Namperumalsamy (popularly known as Dr Nam), flew back home.
“Those early years were very difficult,” admits Dr Nam. “Dr V took no salary at all – he said his government pension was more than enough for a bachelor – and he paid us around Rs1500 a month, less than half what we could have earned outside Aravind. And because Dr V was such a strict taskmaster, we had to work twice as hard.”
Since Drs Natchiar and Vijayalakshmi were always at the hospital, Dr V’s sister Janaky, stepped in to help. A warm, motherly woman with four children of her own, she made sure that her sister and sister-in-law didn’t have the additional burden of feeling guilty because they were away from children and home so much.
“My aunt was not that educated,” says Prajna, Dr Natchiar’s elder son, who was nine when Aravind started and spent a lot of time at Janaky’s home. “But by managing all the domestic issues, she kept the family together. Her contribution was very significant.”
Dr V, of course, was keen that his nephews and nieces become ophthalmologists and work for Aravind.
“Although he never put any real pressure on us as kids,” says Dr S Aravind, the son of G Srinivasan, “he made us hang around the hospital on holidays, talk to patients, find out how many people had been treated each day. And he’d often introduce us to guests saying ‘He’s going to be a retinal specialist,’ or ‘She’s a future cornea person.’ ”
However, if someone was clearly not suited for medicine, Dr V encouraged them to pursue their own interests. “I loved English literature and finding out about things,” says Pavithra Mehta, a grandniece. “So Dr V suggested I study journalism.”
And Dr S Aravind, after dutifully becoming an ophthalmologist, acqui-red an MBA too. Today, like the rest of the family, Dr Aravind maintains a hectic pace. He is the administrator of the Madurai hospital and performs surgery several times a week. Indeed, all the eight nephews and nieces of Dr V who grew up in Madurai – and their spouses – work for Aravind.
Unlike many medical men, Dr V understood the importance of good hospital management, and within a few years of Aravind’s starting, lured his sister Janaky’s son-in-law, R D Thulasiraj, to Madurai. Money, naturally, was not the attraction; in fact, Thulasiraj, an IIM Kolkata alumnus working for a multinational company, took a 70 percent pay cut.
Thulasiraj soon realised that the mild-mannered Dr V had a unique way of enforcing discipline. Initially, not used to starting work at 7 am, Thulasiraj was constantly late. “Dr V didn’t say a word to me,” Thulasiraj recalls, “but started sending his car to pick me up in the mornings. I soon fell in line.”
Thulasiraj also discovered Dr V’s other unusual qualities. For example, he hated being praised. “If anyone did so,” Thulasiraj recalls, “he’d immediately change the subject.”
But perhaps the main lesson Thulasiraj picked up from his boss was that everyone has enormous potential that mostly lies untapped. “Your capacity is determined by how much you think you can do,” Thulasiraj says. “If you feel you can take on the world, that much energy will come to you.”
With Thulasiraj’s management skills harnessed to Dr V’s vision and everyone’s hard work, Aravind expanded rapidly. It built hospitals in four other Tamil Nadu cities, established a plant to manufacture high quality but inexpensive lenses and other ophthalmic products, and started a hospital management consultancy. Aravind today is probably the world’s most influential eye institution: About 10 percent of India’s 11,000-plus ophthalmologists – as well as hundreds of foreigners – have been trained here, and around 250 eye hospitals, in countries ranging from Ethiopia to China, have benefited from its management expertise.
Dr V had an inexhaustible interest in all kinds of things, and in 1990, he decided it was time to widen the horizons of his grand-nephews and -nieces. So he started a “New Age Group” consisting of all the kids in the family. Group members, accompanied by their parents, met every Sunday morning and each child had to research a topic chosen by Dr V and present it to the entire gathering. Subjects ranged from the local Meenakshi temple to why leaves changed colour.
“At first we thought of it as homework,” confesses Pavithra, now 30. “But slowly we grew to enjoy it. Dr V even took notes when we spoke – that made us feel very important. Besides the fun of getting together regularly, these meetings helped the family bond in a special way.”
Although Pavithra is now a journalist and lives in the US, she remains closely associated with the Aravind facility. She has made a film on Dr V and is writing a book on the AECS. And most of the other dozen-odd members of the New Age Group, which lasted for about a decade, plan to work for Aravind, either as doctors or in other capacities.
Dr Usha Kim is operating on a young man who has been referred to her by one of her former students, now practising in Bangalore. The patient had had one eye removed because of an injury, but the implant came out and Usha now has the tricky job of refashioning the man’s socket for another prosthesis. It’s one of 14 operations that Usha will perform that day.
Usha, the wife of Dr Kim, one of Dr V’s nephews, is the first daughter-in-law in the Aravind family to join AECS. She remembers being stunned during her initial days in Madurai, more than 17 years ago.
“The family worked all the time,” she says. “They didn’t seem human.”
Shortly thereafter, she developed a fever and was admitted to hospital. Soon, Dr V, walking slowly and painfully because of his arthritis, came to see her.
“What’s the matter?” he asked.
“I feel awful,” Usha replied.
Dr V looked at her. “I had a 104-degree fever this morning,” he said. “I took a tablet, and I’m OK now. You shouldn’t listen to your body.”
“And since then, I haven’t,” Usha says, laughing. Today, she heads the department that handles problems of the eye socket and eyelids and is also responsible for the training of mid-level paramedics. “I, too, work all the time,” she admits.
The incessant grind is more than compensated for by the tremendous support family members give each other, says Dr Lalitha, the wife of another of Dr V’s nephews, Prajna.
“If I have a problem, I know that I have several people I can depend on to help me,” she says. “We’re all very close.”
Dr V’s family belongs to the Kamma Naidu caste as do Usha and Lalitha and nearly all those who’ve married into it. But eight years ago, Prajna’s younger brother, Vishnu Prasad – already a maverick for studying business management rather than medicine and settling in the US – married a Sindhi girl. That, predictably, caused quite a stir, and Vishnu’s parents were unhappy.
As always, Dr V’s intervention saved the day. “It took him some time,” Dr Natchiar admits. “But he persuaded me to truly accept the marriage.”
In fact Dr V did much more that that – he was able to coax an initially reluctant Vishnu to return to India, much to the delight of his wife Chitra. Vishnu is now the international marketing manager for Aravind’s ophthalmic products.
Although she initially faced problems, Chitra, a finance MBA and full-time volunteer at Aravind’s consultancy division, now feels very much at home in Madurai. “Every day,” she says, “I thank Dr V for bringing Vishnu and me here.”
Adults aren’t invited to Subhashree Krishnadas’s eighth birthday party, but Drs Nam and Natchiar drop in anyway. Walking over to Subhashree, Natchiar hangs an Aravind identity card around her neck, certifying the little girl is the chief medical officer (CMO) of the Madurai hospital.
Since Subhashree – whose father is the hospital’s current chief marketing officer – looks a little worried, Natchiar asks her if she didn’t want to head the hospital when she grew up. “Of course I do,” Subhashree replies. Then, pointing to Natchiar’s nine-year-old grandson Aravind, she says, “But wouldn’t he mind?”
There are two kinds of people in the Aravind Eye Care System – those who belong to the family and those who don’t. And although Dr V laid down that people doing the same job had to get the same rewards and opportunities, whether they belonged to his family or not, being a family member does automatically confer a subtle cachet.
“It’s easier for me to get things done, than it is for my peers who are not part of the family,” admits Deepa Krishnan, Dr V’s grandniece. And it’s likely that some first-rate doctors have left Aravind because they sensed an invisible ‘family ceiling.’
Still, several non-family staff members insisted there was no discrimination at Aravind.
“When the post of Madurai’s CMO fell vacant,” says Subhashree’s father, Dr Krishnadas, “there were two family members and I in the running. We all had the same qualifications and experience. But I was the one who was promoted.” In fact, according to Deepa, belonging to the family isn’t easy. “More is expected of you,” she says. “You have to live up to your birthright.”
Towards the end of the 1990s, Dr V started relinquishing his administrative responsibilities. But he came to the hospital every day, and as he walked about with the help of a cane, some of the newer staff wondered who the old man in a white khadi shirt and old black chappals was. Once a guard told him to wait in the reception area and Dr V sat there quietly until Dr Natchiar arrived. Was that a sign of his innate humility? Or was it simply his shrewd way of checking how the guard would treat an elderly man who’d ostensibly come for help? Certainly, Dr V kept his wits about him until nearly the end, in 2006.
Indeed, recalls Fred Munson, an American professor of hospital management and a close friend, as Dr V’s strength waned, his family continued “growing and developing a little of Dr V in each of them.”
Madurai’s Justice V. R. Krishna Iyer Community Hall is packed. Inside, resplendent in a mustard and gold Kanjeevaram sari, Sathya, Dr V’s grandniece and Thulasiraj’s daughter, is getting married. The groom, Ashok Vardhan, is, like Sathya, studying for a postgraduate degree in ophthalmology at Aravind. The two young people have barely met, but their horoscopes, caste and social background match. In fact, Ashok’s uncle works at the Aravind Eye Care System hospital in Pondicherry, and Ashok, a lanky lad with a full moustache, will work for Aravind too.
Dr V, of course, is not there. But if he were he’d surely be content.
