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Former Aravind administrator guides LAICO, Vision 2020
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When Aravind Eye Care System was just a clinic, no one knew it would become what it is today, especially the administrator who worked with physicians to create “the Aravind model.”
 Mr. R.D. Thulasiraj |
Mr. R.D. Thulasiraj, nephew of the late Dr. G. Venkataswamy, a.k.a. Dr. V, was working as a systems manager for Berger Paints in Calcutta while his uncle ran what was then known as the Aravind Eye Clinic.
“Dr. V had set up Aravind Eye Clinic in a rented house as a small outfit, but he had a big vision,” Mr. Thulasiraj told Ocular Surgery News in a telephone interview.
Part of this vision was to incorporate management professionals into the daily workings of the clinic, Mr. Thulasiraj said.
“When I came on vacation, he would involve me in one thing or another, ... like interview a candidate,” he said. “At that point of time, one had to make a decision about family, whether to settle down in Calcutta or come back.”
Mr. Thulasiraj made his decision more than 25 years ago, and today he is executive director of the Lions Aravind Institute of Community Ophthalmology.
Making the adjustment
In making that decision to join the Aravind clinic, Mr. Thulasiraj went from a large, multicenter, for-profit company to a small organization.
Mr. Thulasiraj estimated that there were fewer than 100 employees in only one location at Aravind at that time, and his job entailed interaction with the patients, which he did not have previously with customers.
“In the manufacturing industry, you almost never come into contact with the customer unless you are in marketing or sales, but in a service hospital, that’s your daily life: patients yelling at you or thanking you or complimenting you,” he said.
“It is a nonprofit, it is service-oriented and it’s a … challenge. At that time, one didn’t know what he was getting into. There were no plans to become what we are today.”
The Aravind model
Slowly, Mr. Thulasiraj and the team of physicians began working together to implement policies and processes.
“In the initial years, I think it was purely sacrifice which built the organization,” he said. “With time, we started putting in different systems.”
Innovations in the surgical and care-giving processes engineered by the physicians are what Mr. Thulasiraj credits with providing much of the work.
“It was very much teamwork; how the model emerged and the model is really hindsight,” he said.
Since those days, Mr. Thulasiraj said there have been small changes, but the core model has only been expanded.
“We have applied the same model of proactive outreach to find patients, to pediatric care through school screening and otherwise for refraction, for diabetic retinopathy,” he said.
“I think the Aravind model, in all honesty, came about not through a management system. The origin really lies in a spirit of service in the sense that Dr. V wanted poor persons to get eye care, and he was willing to make sacrifices to make it happen,” Mr. Thulasiraj said.
Principle of outreach
The idea of proactive outreach still lies at the center of the widely expanded Aravind system, Mr. Thulasiraj said.
“If there is blindness in the community, it is primarily the problem of the community,” he said. “While Aravind has something to offer such as diagnosis, treatment, follow-up, things like that, the community has got to do something about it.”
Therefore, Mr. Thulasiraj said that Aravind requires the community to actively join in the work of eye care.
“We have a very well laid-out process of what is the role of the community. It will vary from finding the (eye) camp site, doing the publicity, how many volunteers we need, what kind of furniture we need,” he said.
Founding LAICO
Once Aravind implemented its own systems and created a self-sufficient entity, it began to be noticed by others, Mr. Thulasiraj said.
“People started noticing that we were doing things a bit differently. We were not doing any fundraising. On the other hand, we were financially self-supporting, even though we’re doing a large proportion of free work,” he said.
Mr. Thulasiraj and colleagues conducted a study of eye care in India, which he said showed that “there is a lot to be done in enhancing the efficiency of the system in the rest of the country.”
Internally, officials began discussing the possibility of opening a training institute to provide instruction for others. This discussion continued while the Lions Club International SightFirst program began looking to support a new hospital in India.
Aravind offered to work with the Lions on a training institute, which became the Lions Aravind Institute of Com- munity Ophthalmology, or LAICO.
“They immediately saw the synergy,” he said. “They really wanted a place where people could be trained, especially in eye care management.”
Improving others and within
Working with other institutions through LAICO not only improves their output but also helps Aravind, Mr. Thulasiraj said.
“It’s very satisfying to see hospitals often double what they are doing within a year’s time of engaging with us,” he said. “They also become financially independent in their operating costs.”
Since its inception in 1992, Mr. Thulasiraj said LAICO has worked with about 230 hospitals.
“We honestly feel that we have probably added to the eye care industry at least about 500,000 to 750,000 additional surgeries per year through enhancements,” he said. “All the work is done by those hospitals, but we had a small role to play in putting them in the right way of thinking and changing their paradigm.”
In addition, Mr. Thulasiraj said teaching is a way of helping oneself to further refine internal procedures.
“To put it in a crass manner, the best way of learning is from other people’s mistakes,” he said. “That apart, I think when we try to teach a principle, I think it clarifies a lot to ourselves as much as it may do for those being trained.”
The cooperation with Lions and the success of LAICO has also brought a tremendous amount of visibility and a certain amount of recognition in the international scene that, Mr. Thulasiraj said, increases internal pride among employees and the amount of people wanting to cooperate further with Aravind.
Vision 2020
The other role that Mr. Thulasiraj serves in Indian ophthalmology is as president of Vision 2020 — The Right to Sight, India, in which he works toward nationwide improvement of eye care.
“We were able to lobby with the planning commission and the ministry of finance to significantly increase the allocation for eye care,” he said.
The previous year’s plan allocated $125 million, whereas this year’s plan allocates about $400 million.
“We want the whole eye care in India to kind of go beyond cataract services, so we want to see it go into pediatric care, low vision, diabetic retinopathy and also address simple but neglected conditions like refractive errors,” he said. “We’re hoping to stimulate much broader coverage of eye care and then move ahead.”
Mr. Thulasiraj also said he is looking to improve training and additional care throughout the country.
“We would also like to see good primary care network and good tertiary care facilities because we are fairly strong on the secondary level,” he said. “We are also hoping to see this program enhance the quality of care starting from training.”
Continuing the vision
Today, although much larger than when he joined in 1981, Mr. Thulasiraj said Aravind Eye Care System continues in the vision that Dr. V set forth.
“We are now finished 30 years of existence, and each decade has been a different kind of a decade,” he said. “The last decade, we have laid the foundation to scale up significantly, and we have in fact set a goal in 2005 that we will become a million surgeries organization by the year 2015.”
One way he said Aravind is working to achieve this goal is through managed care eye services in which the organization is partnering with socially minded individuals to establish and run new eye hospitals in areas of need.
“On the training front, we are trying to consolidate and form all our training programs as a university so that requires a lot of work to be done,” Mr. Thulasiraj said.
For more information:
- R.D. Thulasiraj can be reached at the Lions Aravind Institute of Community Ophthalmology, Aravind Eye Care System, 72 Kuruvikaran Salai, Gandhi Nagar; 452-2537580; fax: 452-2530984; e-mail: thulsi@aravind.org; Web site: www.aravind.org.