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Chairman of Aravind continues its legacy
 P. Namper- umalsamy |
Aravind Eye Hospital began in a house with just 11 beds, but it began with the same principles that it still holds today.
“Our motto has been we should not turn down any patient just because they don’t have money,” P. Namperumalsamy, MBBS, DO, MS, Aravind chairman, told Ocular Surgery News.
Despite the passing of its founder, Govindappa Venkataswamy, MD, in 2006, Aravind Eye Hospital continues its mission of service, training and now research, thanks to Dr. Namperumalsamy.
The chairman said physicians mortgaged their houses to pay for the construction of the first hospital; when the rooms were done, they moved in furniture from their homes.
“It’s funny to think about now,” he said. “Now we have five hospitals in five locations... We have almost 4,000 beds from just 11 beds.”
Why ophthalmology?
When Dr. Namperumalsamy completed medical school in 1963, he was unsure what path to take with his career.
“There was no guide or anything to show what is the next thing I have to do,” he said.
By chance, he said, Dr. Venkataswamy, known affectionately as Dr. V, picked him to marry his sister, who was also a medical graduate and now serves as director of Aravind’s human resource department. With this, Dr. Namperumalsamy’s career was set in motion.
“That didn’t force me into ophthalmology but gave me an opportunity,” he said.
Dr. Namperumalsamy and his wife joined government service in the medical college in Madurai as assistant professors of ophthalmology. They had the opportunity in 1972 to train in the United States at the Eye and Ear Infirmary in Chicago.
Afterward, they returned to government service. Five years later, Dr. Namperumalsamy applied to return to the United States for further training but was denied permission by the government.
At the same time, Dr. V retired and began his own private practice. So Dr. Namperumalsamy and his wife left government service and attended the Massachusetts Eye and Ear Infirmary at Harvard in Boston, where he underwent training under Dr. Charles L. Schepens.
“When I came back, naturally, I had to come join my brother-in-law. That is how I joined Aravind Eye Care system,” Dr. Namperumalsamy said, laughing. “I had no other choice.”
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Images: Namperumalsamy P |
Differential payment
In the early days of Aravind, Dr. Namperumalsamy said physicians there were well-established as the leading ophthalmologists in the community and had a good reputation.
“The basic fundamental thing for success of our hospital, of our people, is that we always work with the community,” he said.
Dr. Namperumalsamy said they developed the system of no appointments and payment on the basis of what patients say they can afford.
“Anyone who comes in should be treated,” he said. “That is the principle we took from the very beginning: that money is not the only thing.”
This developed into the differential payment system in which patients pay what they wish for certain amenities.
“If they want to have a private room, they have to pay 10 times more than what it exactly costs, but also we explain to the patient: This money, we are not going to take it. Whatever extra money you give, it will support another 10 free patients who cannot afford to pay,” he said.
Today, this mentality remains, Dr. Namperumalsamy said. “Our aim is to give 70% free and 30% paid.”
Self-sustaining process
The physicians quickly began working and putting revenue back into the hospital, Dr. Namperumalsamy said. They invested in necessary equipment but not the latest technology.
“When you invest in any heavy equipment for luxury purposes or anything, you will have a bank loan you money, and your mindset will always be to earn that money,” Dr. Namperumalsamy said. “You will charge more.”
Gradual improvement was their goal, he said.
“We never did go for fundraising,” he said. “We didn’t want to be obliged to anyone, even the government.”
Aravind began manufacturing its own IOLs and medications to provide low-cost options to its patients and now other hospitals as well.
“Medicine is so expensive,” Dr. Namperumalsamy said. “If you reduce that by 90% of the cost, how much money do you save for the patient, for the hospital? That money again can be put back to the hospital.”
Currently, Aravind Eye Care System runs Aurolab, which manufactures about 2,500 lenses per day, he said.
“It was meant only for Aravind,” he explained, but it now services other hospitals within India and internationally.
“We make money and that money we can get it back to the hospital and the lab,” he said.
Training personnel
More and more patients pushed Aravind to begin training its own physicians and nurses, Dr. Namperumalsamy said.
“When the demand goes up, we have to have more people,” he said.
They applied for Aravind to be a training institution through the Madurai University and were quickly approved.
Aravind has expanded and now has top programs in many subspecialties, such as glaucoma and retina.
“People from all over the country, after their post graduation, they come there for further training,” he said.
Today, with the help of the Indian Space Research Organization, Dr. Namperumalsamy is involved in setting up virtual education systems to further expand the reach of Aravind training.
“We thought we would start an Aravind virtual academy so that the training would go not just to the Aravind people but also it will be available for the entire country,” he said.
Aravind also began training nurses, Dr. Namperumalsamy said. Local teenage girls were trained in nursing and in assisting the ophthalmologists in surgical and diagnostic procedures.
“We thought that it’s not necessary that, in the steps of surgery, everything should be done by a doctor,” he said.
The number of surgeries one surgeon could perform increased from an average of two to at least six per hour, with turnover, Dr. Namperumalsamy said.
“By the time you do surgery, these nurses will prepare the other patient,” he said. “You just walk to the next patient.”
What started with two or three registered nurses training new recruits expanded to the current number of at least 800, Dr. Namperumalsamy said.
Aravind also has training partnerships with other medical institutions such as in the United States at Wilmer Eye Institute at Johns Hopkins University, Massachusetts Eye & Ear Infirmary and Joslin Diabetes Center of Harvard University, he said.
“We have established collaboration with the universities [in the U.S.] so we can always keep up with the technology,” and at least 25 residents come to Aravind every year for a month of training, he said. “Previously, Indian doctors used to go elsewhere for training. Now we have reversed that.”
“I’m proud of my academic affiliation with the universities and producing more qualified doctors,” Dr. Namperumalsamy said. “Everywhere, they get immediate jobs. ‘Are you Aravind certified? Yes? OK, you’ll get a job.’ That kind of thing satisfies you.”
He said, “Those kinds of human resources capabilities also help the self-supporting nature of Aravind.”
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Managing it all
After training medical personnel, Dr. V and Dr. Namperumalsamy realized they needed more assistance in managing the hospital and its outreach efforts.
“The doctors are here waiting for them, but the patients are there waiting for someone to take them. So there must be some link,” Dr. Namperumalsamy said.
In 1982, Aravind brought in a well-trained MBA to help them begin.
“We found the importance of management capabilities in doing this kind of work,” the chairman said. “You must use all the available resources to the maximum in order to cut down the cost.”
As the hospital expanded, so did the need for management of the various sectors and for those management personnel to understand the Aravind mission.
“It’s not an IT industry with computers. You are going to be dealing with humans,” he said. This spurred Aravind to begin a training institution for hospital management, and this initiated the Lions Aravind Institute of Community Ophthalmology (LAICO), a unit of Aravind Eye Care System.
After organizing Aravind, he said they began offering their training system to others as managed care hospitals.
Aravind and LAICO work together to conduct needs assessments and help poorly performing hospitals.
“Work with them. Bring them to the hallmark hospital. Keep them for at least a week to expose them to all this methodology at work, and then put them back again,” Dr. Namperumalsamy said. “We have done almost 227 hospitals so far.”
He said they are using technology for daily management as well.
“All our five hospitals are connected by videoconferencing,” he said. “If I want to have lecture classes for my postgraduates, talk to my administrators, managers, financials, I just tell my telemedicine operator desk I want to talk to all of these people, and they are there on the screen.”
Aravind implemented telemedicine in rural areas, which has spread to mobile vans and 19 vision centers in the villages that are integrated for teleconsultations with the main hospital, he said.
Expanding and growing
The chairman’s personal goal was to move from a cataract hospital to one that treated all ocular problems and worked in research to find better treatments.
“It should have confidence and specialize in each and every area,” he said.
Today, there are many experts as well as training and reasearch opportunities, Dr. Namperumalsamy said.
“Always, my passion was for research, but the priority was not given initially,” he said. “Other things would bring in money, patients, revenue, but research doesn’t. But research has to be done.”
One of the first research projects that Aravind undertook was field research to improve its outreach efforts.
“Identify the barriers, address the challenges of the barriers and rectify them. That was our first priority in the field research,” he said.
Aravind moved on to medical research, especially genetic research within its local communities.
“The genetic research can be done very well because of the closed community,” Dr. Namperumalsamy said. “It will be useful for the entire world.
Aravind laid foundation for an exclusive eye research institute named after its founder, Dr. V, Dr. Namperumalsamy said. The building will be five stories and house state-of-the-art research facilities to do research in every field. He estimated it will open later this year.
“With the changing times, we have to change, keeping the quality, keeping the service and at the same time, affordable to our kind of people,” he said.
For more information:
- Dr. P. Namperumalsamy, MBBS, DO, MS, can be reached at Aravind Eye Hospital, 1, Anna Nagar, Madurai - 625 020, Tamilnadu; +452-435 6100; fax: +452-253 0984; e-mail: dr.nam@aravind.org; Web site: www.aravind.org.