Infinite Vision 9-9-13

Anderson, South Carolina

Fifteen years ago while getting ready to go to my office in the hospital my central vision suddenly dropped out. Thinking myself in the midst of an evolving stroke, I went to the emergency rooms in a severely agitated state of mind and body. Very expensive testing and evaluation revealed I was instead having an ocular migraine; a rare variant with the auditory and visual manifestations, but none of the usual intense pain. The experience provided a powerful learning experience in the value of vision and knowledge. Since then I’ve had hundreds of these without pain and or fear. Knowing what they are has reduced them to curious neurological experiences. As I write this, I am seeing the scintillations and other curious phenomenon associated with these poorly understood neurological firestorms. Just now it was a challenge lining up the toothpaste with my brush.

An estimated forty million people in the world are living with permanent blindness because of a much slower process, the crystallization and hardening of their eyes; cataracts are the largest causes of treatable blindness. For those living in the developing world, blindness is tantamount to a death sentence. Those who cannot see to work are abandoned by their families, marginalized by desperately competitive and under resourced societies. In India blindness is seen as a terminal disease; life expectancy being little more than two or three years after onset. Blind people are referred to pejoratively as ‘mouths without hands,’ liabilities in desperately poor environments where everything is scarce.

Three years ago I was wandering around in the great orthodox cathedrals of Russia and its former satellites taking photographs when I mis-stepped off an unseen altar dais, stepping down hard a mere eight inches. That night I began seeing stars where there were none. Unlike the fascinating scintillations I have seen hundreds of times these stars were ominous and taken as warning of something more sinister; a wisp of dread spread over my being. I had retina surgery the day I returned to the United States.

For more than a century there’s been a vast disparity between quality and accessibility of medical care in the developing world and that available in Europe and North America. Retina repairs and cataract removal are outpatient procedures in the developed world. In the most populous nations on earth their unavailability because of finance barriers or lack of facilities and trained surgeons make easily corrected ophthalmic problems into death sentences. I got on a plane, crossed eight time zones, and had surgery the same day for a $35 co-pay.

Sixty years ago Govindappa Venkataswamy was discharged from the Indian army because of a severe crippling form of rheumatoid arthritis. Dr. V. as he was known locally, also had vision, infinite vision. He believed it possible to treat all forms of preventable blindness, making care accessible to all economic and social strata of society, even in India where a long entrenched caste system and widespread poverty has made access to healthcare and sanitation little more than a distant daydream for hundreds of millions. Despite crippling arthritis in his hands and feet he successfully performed more than one hundred thousand cataract surgeries. Thirty five years ago he founded the Aravind Eye Hospital in Madurai, India as an eleven bed clinic in his brother’s house. He mortgaged the family jewelry when banks wouldn’t touch his eccentric business model.

Presently Aravind consists of nearly a dozen hospitals with more than three thousand beds delivering the highest quality ophthalmic surgery in the world to all who seek care; sixty percent of Aravind patients pay nothing. Patients are free to pay or not pay. There are no classes of care. All receive current state-of the art care with ocular implants. In 2012, three million outpatient visits and 349,000 surgeries were completed with outcomes equal or better than in North America or Europe. Average cost of a hospitalization including all services, intraocular implants, surgery, and follow-up is $35, and this is optional to the patient. The Aravind system is financially self-sustaining and generates a substantial operating surplus despite giving away most of its care and accepting no public moneys and giving world class care for less than a penny on the dollar. As the largest provider of eye surgeries on earth, the Aravind Hospitals provide seven percent of all eye surgeries in the world.

Some of the most powerful and inspiring business case studies have been written at Aravind and are used the world over. Biographies of the late Dr. V are page turners, impossible to put down. Alas, what is often missed in these is the true nature of Dr. V’s surreal successes. It had nothing to do with process engineering, outcomes research, huge development grants, or a massive influx of NGOs and experts.

Pavithra K. Mehta in her book Infinite Vision explores the spiritual vision of Dr. V. It’s well documented Dr. V long followed the teachings and precepts of several beloved spiritual teachers and embraced his own daily disciplines of spiritual practice and renewal. One is left wondering how insight and intuition gained from private spiritual practice translate into the most cost effective healthcare delivery system on the planet. Mehta articulates how Dr. V. would often get visions and insights regarding operational decisions years before their fruition. Seeming contradictory or counter intuitive at the time, the wisdom of these insights has long since been validated. One will not find the usual formula. Dr V’s formula was simply this:

Intelligence and capability are not enough. There must also be the joy of doing something beautiful. Being of service to God and humanity means going well beyond the sophistication of the best technology, to the humble demonstration of courtesy and compassion to each patient.

The veracity of these spiritual precepts has informed the life and work of Dr. V. and the Aravind Eye Hospitals since the beginning. Thirty two million patients will ‘like’ Aravind Hospitals if given the chance. When we do something out of love, the outcomes are guaranteed, every time.

Love never fails. But where there are prophecies, they will cease; where there are tongues, they will be stilled; where there is knowledge, it will pass away. For we know in part and we prophesy in part, but when completeness comes, what is in part disappears. When I was a child, I talked like a child, I thought like a child, I reasoned like a child. When I became a man, I put the ways of childhood behind me. For now we see only a reflection as in a mirror; then we shall see face to face. Now I know in part; then I shall know fully, even as I am fully known. And now these three remain: faith, hope and love. But the greatest of these is love.

Blessings,

Craig C. Johnson