Infinite Vision

January 25, 2021 [books] #business #india #books

Book: Infinite Vision
Author: Pavithra Mehta

Looking back on my years in India, I realized a while ago that I didn't have many examples of excellence from the subcontinent growing up, outside sport and culture. Since I only consumed books in english as a child, my heroes were all British or American. Or folks that the Brits or Americans regarded as exceptional, who almost always turned out to be from the West. Edison. Faraday. Maxwell. Newton. Einstein. There were some exceptional Indians I was aware of though, in part due to conversations with my mother and uncle, both part of the ISRO/DoD universe - Homi Bhabha, Satish Dhawan, CV Raman. Of them, all I knew was that they were institution builders, which back then I didn't think much of. No case studies, no narratives about the effort it takes to build these extremely effective scientific institutions in India. Nothing to inspire a child. As a consequence, they did not have as much of an impact as these other, better documented lives.

Only lately have I realized that India over the last century has produced some remarkable people who have had an outsized impact on the country, and directly or indirectly, on me. There are engineering, scienc-y, non-traditional heroes in India, the anglophone world just doesn't talk about them. And by the virtue of the media I consume, I have remained ignorant of their achievements so far. I am trying to compensate for it now, well into adulthood. At the very top of this list is Dr Govindappa Venkataswamy (Dr. V), and the organization he started, Aravind.

Aravind is a chain of eye hospitals based out of Madurai. By all measures it's enormously successful. Aravind has a presence in many big and small towns in Tamil Nadu, and in Tirupati, Andhra Pradesh.  Aravind also has partnership projects in Calcutta, India, Nigeria, Bangladesh. Aravind, via Aurolabs, also make intraoracular lenses, manufacturing and selling these lenses at a fraction of the cost it sells in other countries. Most of Aurolabs profits in turn go to charities. But what's remarkable about Aravind is not its growth and success. It's the model in which it's run that belies belief. Aravind is for all means and purposes a charity. No, it doesn't accept donations, but patients are free to pay what they want for its services. No obligations. Aravind might be most successful eye care clinic in the world. In its 40 year existence, it has treated nearly 32 million patients and successfully performed 4 million surgeries, with a complication rate less than that of UK hospitals. In the context of India's largely unregulated health care system, this is remarkable, along with the devotion to quality expressed by Aravind. How can a business whose model is based on "pay-as-you-like" thrive? To answer that question, we must go Dr V.

Ralph Waldo Emerson said institutions are lengthened shadow of the men who found them. This is true as far as Aravind is concerned. Dr V wanted a career in obstetrics, and found his dreams crash when he became permanently crippled by rheumatoid arthritis. He remained phlegmatic, “It was difficult, but then you move on.” He turned to the eye department in his university instead. Operating on the eye required more nimble skill than physical strength in the fingers. He still had to train his gnarled fingers to hold the scalpel and cut the eye for cataract operations. He did that, through his official career, running government programs. By the time he was 58, India’s mandatory retirement age from government service, Dr. V had served as an ophthalmologist, an educator, and a national public health figure. He had already personally performed over 100,000 surgeries, pioneered a hugely successful outreach model, trained hundreds of young doctors as vice principal and dean of the Madurai Medical College, and been awarded a Padma Shri (one of India’s highest honors). He then decided, at his retirement, he would dedicate the rest of his life to eliminating needless blindness. To do that, he recruited his siblings, and they joined without needing much persuasion. After all, he brought them up, and for all means he was their father. In India, at one time, this was enough. He did not have capital or business, but he did have a punishing work ethic, and that would do at the beginning.

Aravind, right from the start, was conceived as a vehicle to eliminate blindness, not make money. Its purpose was set. Every action will revolve around compassion. No compromise on quality. The only question was how to build a self-sustaining organization around that purpose. It would not depend on charity and it needed to be self-sufficient. His sister, Dr. Natchiar, says:

“Dr. V was able to get into the lives of the patients. Before they suffered, he suffered. ‘Blindness kills a person every day,’ he used to say. ‘It takes away their sight, respect, and decision-making authority. Our job is not just to bring them vision,’ he would tell us. ‘How do we get them back their dignity?’"

How did Dr V manage to pull it off? Among other things, he was a systems thinker before that term became popular in the valley. He viewed blindness as  a systems problems with severe consequences for the society. First he tackled the pipeline problem - getting enough patients to come to Aravind. If they wouldn’t come, he would send buses to villages to bring them in, for free. Then he focused on the quality of the hospitals itself. It had to look like a hotel. People should feel safe there. It should reflect that Indian ethos, “athiti devo bhava”, and not repel people. Then there was the recruiting. Since the problem he was solving needed compassion foremost, he didn’t focus on skills. He regarded character as more important and hired young women. Training he could offer. Character would be harder. He had protocols for everything - hiring, devising career tracks for employees, mentoring individual doctors into leadership positions. Most importantly, he ensured that the personal growth of his doctors and nurses and staff was tied to the growth of Aravind, and that there was no conflict on interest. Anything that would drive and reinforce the core values of equitable care, high quality, compassion, and transparency. "He knew that strong, mission-aligned processes and protocols could mitigate the threat introduced by individual deviations. In an organization that functioned at such a massive scale, this was all the more important”, says Fred Munson, a friend of Aravind and Dr.V. There’s a remarkable anecdote by Dr. Ramachandra Pararajasegaram, a consultant with the World Health Organization. He had travelled with Dr.V for a conference: “In Frankfurt, we were at the airport together, and he called me to watch a plane land. You could see one trolley coming to take baggage, another for loading the trash. ‘That’s how we should run our operating theater,’ Dr. V said. He is able to pick up cues like that. He even asks housekeepers at hotels about their training curriculum and the proper method of bed making. He has that kind of inquiring mind, and he applies the lessons he learns to Aravind.”

Dr V spent all his time thinking about making Aravind serve its purpose. His journals record his obsessions. "How to bring that hospitality and culture in our hospitals and camps. The ordinary man must feel at home. At Aravind, the nurses—themselves from villages—are beacons of comfort, guiding patients through the maze of medical care. Their specialized skills, honed by repetition, not only enhance quality and allow for high patient throughput but also nurture a sense of individualized care. I have been doing yoga since 1936, from the age of 18 years, consciously, or unconsciously. My interest in my profession is how to make this work a field for inner growth and perfection. Aravind Hospital aims at bringing higher consciousness to transform mind and body and soul of people. It is not a mechanical structure repairing eyes. It has a deeper purpose. Intelligence and capability are not enough. There must be the joy of doing something beautiful. Institutions should be like temples. I must spend more time developing the children mentally and physically," (He uses the word yoga to define any movement toward perfection. In medical school, Dr. V had a professor who upheld Sri Aurobindo’s maxim “All life is yoga.”)

Yoga. Sri Aurobindo. Higher consciousness. Dr. V’s engine of personal transformation was his spirituality. In one of his journal entries he asks “How do I become the perfect instrument?” One cannot divorce Aravind’s success from Dr V, and likewise Dr V’s from his “sadhana”. He spent every morning with Sri Aurobindo’s Savitri. Before starting Aravind, he consulted the “mother” at Auroville - Aurobindo’s Ashram in Pondicherry. He regarded his work as a means to transcendence. This reminds me of something that Gandhi once said in his journals: “What I want to achieve—what I have been striving and pining to achieve these thirty years—is self-realization, to see God face to face... All that I do by way of speaking and writing, and all my ventures in the political field, are directed to this same end.” Dr. V believes Aravind’s work is a manifestation of Sri Aurobindo and the Mother’s influence. Whether this is true is irrelevant. The objectives, systems, and culture of Aravind certainly do not demand belief in spirituality. But the fact remains that they were created and distinctly shaped by one man’s sense of an inner reality. This is why you cannot give short shrift to Dr. V’s spirituality when tracing the path of Aravind’s evolution. It threads through everything: his priorities and perspectives, his vision for Aravind, his leadership practices, and the unique impact he has on the people who work with him. It is what linked this man’s individual quest to the evolution of the largest eye care facility in the world.

If this is the effect religion has on some people, there should be more of it.

Dr V was fond of pointing out that the Madurai Meenakshi Amman temple, whose proud towers stud the skyline of that city, was not the work of a single ruler. It was a creation of dedication, ingenuity, and selflessness that spanned multiple generations. And the result is a transcendent gift to the world. According to Dr. V, it could be the same with institutions. This was part of his aspiration for Aravind, and because of it, he held himself and his team to a set of powerful, unwritten directives.

I am glad to have discovered Dr V this past year. And I am glad this book exists, especially in these cynical times where anything related to India or religion is only examined with a hyper-critical lens. Aravind Eye Hospital, Madurai is proof ethical wealth creation is possible, and compassionate businesses can not just exist, but thrive.

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