MADURAI, India -- Govindappa Venkataswamy has a vision: to eradicate avoidable blindness in his lifetime. A solution could be in sight for millions of people if the 80-year-old Indian ophthalmologist can spread his prescription for providing high-volume, high-quality eye care at low cost around the developing world.

"The secret is commitment and a market approach," says Venkataswamy. Eye care in developing countries, he argues, should be marketed like American fast food. "My model is McDonald's. They serve the identical hamburger, with the same efficiency, at thousands of outlets."

The doctor is promoting compassionate capitalism.

Thanks to sound management, innovative marketing and an assembly-line approach to surgery, his Aravind Eye Hospital restores sight to more people than any other hospital in the world.

This year, the main hospital and its three branches in the southern state of Tamil Nadu are expected to operate on 150,000 people, mainly cataract victims. Surgeons at Aravind each perform about 2,000 cataract operations annually, compared with an Indian average of 250.

Aravind's efficiency is the theme of a case study at Harvard Business School. Several U.S. medical programs send residency students to the hospitals for training. Health officials from China, Nepal and Indonesia, among others, have sought his advice. The World Bank, sponsor of a multimillion dollar blindness-control project in India, has enlisted Aravind in its training efforts.

"It's not hype, it's the real thing," says Dr. Morton Goldberg, director of the Wilmer Eye Institute at the Johns Hopkins University School of Medicine, which sends residents to Aravind each year. "It takes a unique combination of devotion, technical skill, managerial and organizational ability and entrepreneurship. They are doing it without cutting any corners."

About 80 percent of reversible blindness is caused by cataracts, or the gradual clouding of the eye's lens. A 20-minute procedure to remove the blurred lens and implant a plastic lens cures most people before the condition deteriorates into blindness.

In India, about 17 million people suffer from cataract blindness, many of them as young as 40 years old. Though about 3 million cataract surgeries were performed nationwide in 1997, twice as many as six years earlier, hospitals cannot keep up with the backlog: The disease blinds another 4 million Indians each year.

Dr. V, as Venkataswamy is known to staff and friends, believes hospitals can cure all the needy if they follow sensible business practices. With no state aid and little foreign assistance, Aravind Eye Hospital provides two-thirds of all surgeries free. Last year's $2.4 million profit was plowed back into the system.

"Rich or poor, we never refused a single patient at any time," he says. Instead, Venkataswamy kept lowering the unit cost of surgery by boosting volume, and by engendering among his staff a work ethic and commitment to heal that inspire many to work 12-hour days six times a week.

The operating rooms illustrate the cost-effectiveness and efficiency that bolster Aravind's productivity. A single large microscope swivels back and forth between two operating tables to optimize a doctor's surgery time.

As soon as the first operation is completed, the doctor turns to the other table and begins work on another eye. Meantime, the operating table used previously is prepared for the next patient.

"It's very efficient without sacrificing patient care," says Dr. Roy Loo, a resident from the Greater Baltimore Medical Center doing a stint at Aravind.

Venkataswamy launched his crusade against blindness as a young doctor in the state-run health system. When he retired at age 58, he sank his life savings into his own 11-bed clinic. It flourished into his present network of hospitals with 1,300 beds.

The equipment is the best, but no money is wasted on frills. Patients are carried on canvas stretchers fitted with bamboo poles. Paramedics are responsible for administrative and counseling tasks, freeing surgeons to use their time to restore eyesight.

Five years ago, Venkataswamy acquired U.S. technology to start in-house production of the plastic intra-ocular lenses, which until then were imported at huge expense. Besides bringing down the retail cost of lenses on the Indian market, Aravind now sells them to 75 countries at about one-quarter of the U.S. price. Six months ago, Aravind used German technology to begin manufacturing the tiny suture needle used in eye surgery.

Paying patients subsidize the poor. In Madurai, the hospital is split into two wings. Patients in the commercial wing pay about $130 for surgery and two nights in a private room. In the free wing, patients pay the cost of the lens and suture, about $12, if they can afford it. They receive free meals and free lodging: straw mats in wards for 30 to 40 people.

Neither wing accepts appointments. Patients who arrive on early-morning trains from the countryside start lining up at the hospital at 4 a.m. Toilet and bathing facilities are available, and coffee is served free of charge. The hospital is open Monday through Saturday, starting at 5 a.m.

Sundays are reserved for rural mobile camps that screen hundreds of people for eye ailments and identify those who require surgery. A marketing representative taps local businesses to support the project with publicity. Industrialists usually sponsor buses to transport patients to Aravind hospitals.

S. Muthrurangan, a 62-year-old day laborer, says he had no idea sight could be restored to his left eye so "easily and quickly" until the camp was held in his hometown of Salem. He and 185 other residents of Salem and outlying areas boarded a bus to Madurai one Monday. Two days later, sporting green eye patches over their operated eyes, they returned home.

"For $12, he can be back to work in four or five days," says Venkataswamy. "The economic payoff is immense."

He plans to open one more Aravind hospital in Tamil Nadu next year. But he knows that in the long run, the solution to blindness is not building more facilities: It is helping eye doctors and hospital administrators at hospitals in India and abroad replicate his model. "We want to go global," he says.

The eldest child of a well-to-do farmer, Venkataswamy raised his two brothers and two sisters after his father died. He never married. Several family members, including his sister, brother-in-law and nephews, work at the hospital as surgeons and administrators.

The silver-haired doctor, who stopped performing surgery eight years ago due to arthritis, starts and ends each day at the hospital in the meditation room. But he doesn't consider himself religious. "You don't have to be a religious person to serve God," he explains. "You serve God by serving humanity."

Pub Date: 11/17/98