Q&A: The Culture of Medicine Runs on People Power, Not Tech

Improving global health isn't just about increasing access to tools or technology -- it's cultivating the right kind of people that matters most

eyeexam-615.jpgVillagers undergo eye examinations at a camp organised by Aravind Eye Care System in a village outside Madurai, India. (Reinhard Krause/Reuters)

One of the stars in the global health community, especially when the topic turns to affordability of care, is the Aravind Eye Hospital in South India. Founded by Dr. Govindappa Venkataswamy ("Dr. V") in 1976, the Aravind group of hospitals and clinics is renowned for performing hundreds of thousands of sight-restoring eye surgeries each year. The organization has effectively turned certain ophthalmological procedures into assembly line operations, thus delivering fast, high-quality surgeries at a low cost. Surgery to treat cataracts, for example, costs less than US$20 for patients who can afford it; patients who can't afford the fee are fully subsidized by those who pay. In the United States, the same procedure can cost several thousand dollars.

As a result, Aravind is frequently praised not only in discussions of global health, but also when the topic turns to for-profit social enterprise -- businesses that have a social cause. As economies slow worldwide, the international development community has turned to social enterprises as an alternative to donor-funded programs. The reasoning goes that if philanthropic largesse can't be counted on during times of economic austerity, public services must be run on a for-profit model. Fans often suggest that Aravind's methodology could be applied to primary care, or that the model should be exported to the developed world, which is itself struggling with the costs of healthcare.

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The "model," however, is not so easy to duplicate in part because it depends on hard-to-measure qualities that stump technocrats. At the Pacific Health Summit in London two weeks ago, where the theme was technology and affordability, I spoke with Aravind's chief medical officer, Dr. Rengaraj Venkatesh.

KT: How long have you been on the staff at Aravind Eye Hospital, and what is your current role there?

RV: I started at Aravind from almost the beginning as a medical intern. I was drawn to the mission and have remained there ever since, working my way up as a surgeon and medical officer. Today, as chief medical officer, my role is to supervise the training and operations of our medical staff. We have 45 ophthalmologists, 300 nurses, and an array of other staff who support the doctors and nurses. Because of the time we have invested in process and management, most things run themselves on a day-to-day basis. I'm usually called in to handle unusual situations and emergencies. I also continue to perform 60 surgeries a week.

KT: Given the success of Aravind's approach, many people are eager to see it expanded: to other parts of India, to other developing regions, to other areas of medicine, and even to the developed world. What has Aravind done along these lines?

RV: We are always very happy to share our approach with others. There are now successful eye hospitals in Malawi and Nigeria, for example, that we have helped to set up, and a team from the United States is trying to adapt the model there.

Presented by

Kentaro Toyama is a visiting scholar at the School of Information, University of California, Berkeley. He is working on a book tentatively titled Wisdom in Global Development: A Different Kind of Growth. For more information, see KentaroToyama.org. More

Kentaro Toyama is a visiting scholar at the School of Information, University of California, Berkeley. He is a leading researcher on international development, who focuses on the potential and the limits of information technology to address the challenges of global poverty (about which he writes a blog here). Toyama graduated from Yale University with a Ph.D. in computer science and Harvard University with a bachelor's degree in physics. He is working on a book tentatively titled Wisdom in Global Development: A Different Kind of Growth. For more information, see KentaroToyama.org, and follow him on Twitter: @kentarotoyama.

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