MADURAI, India — M. Senthil Kumar was 12 and living in a rural Indian village in Tamil Nadu, when he started feeling flu-like symptoms and a burning in his eyes. He was suffering from Stevens-Johnson syndrome, a severe skin condition often caused by a medication or infection. Considered a medical emergency, the disease usually requires hospitalization, but Kumar did not get immediate care, and he lost the sight in both eyes.
For 18 years he navigated the world in darkness, losing hope of ever regaining his vision. But in 2013, medical advancements offered a solution. Kumar was fitted with a corneal prosthetic device called Auro K Pro that restored his eyesight. The surgery cost Rs 700, or $11.30.
The Auro K Pro is manufactured by Aurolab, a sprawling ophthalmic consumables facility run by Aravind Eye Care in the South Indian city of Madurai. For over four decades Aravind Eye Care has treated 48 million patients from all over India and performed 6 million surgeries without depending on external donations to fund its charity work. Over half of its procedures are offered free or at steeply subsidized rates. This was made possible by their breakthrough in manufacturing high- quality ophthalmic consumables at a fraction of the previous market rate.
I meet Dr. G. Natchiar, 77, ophthalmologist, director and founding member of Aravind Eye Care system on a blazing hot summer afternoon. She hops off her motorized scooter—a vehicle she laughingly refers to as her “Benz”—which helps her zip around the 80 acres of lush farmland surrounding Aurolab that she has tended to since her retirement. Attached to the scooter is a large blue umbrella, a contraption fashioned by her gardener. “You don’t need a fancy degree for innovation,” she says. “Often simple thoughtfulness would do.”
That philosophy lies at the heart of all endeavors here, especially the self-sustaining, eco-friendly measures adopted by Aurolab. We pass large troughs of compost rich soil, ridden with earthworms and watch as a worker collects cow urine and dung to make organic manure. A few feet away is an artificial lake, fashioned from a dry barren quarry by rain water harvesting. Recycled water is used to nourish lawns, gardens and irrigate agricultural fields and solar power fuels many areas of the plant.
The story of Aurolab is indeed one of the most remarkable examples of the prop roots that hold up the Aravind system, each enabling the other’s success. On the surface, Aurolab is like any other manufacturing facility with a modern, efficient assembly line. Its five divisions produce a wide range of products—intraocular lenses (IOLs), surgical sutures and blades, pharmaceuticals and ophthalmic implants that are exported across the globe.
Delving deep into its 25-year journey has the potential to unlock the secrets of an affordable healthcare model that has gained global recognition. Here is evidence enough of how vision restoring cataract surgery became an accessible reality for millions in developing countries such as India.
“In the 1980s, surgery for cataract involved a very different procedure than what it is today,” says Natchiar. “We removed the clouded, diseased lens in the eye and provided patients with thick glasses that they would need to use all their lives. Even after successful surgery, the quality of vision wasn’t good. There was no depth perception. Peripheral vision suffered.”
However, this wasn’t because surgical solutions for cataract hadn’t yet been invented. The first IOL (intraocular lens) implant surgery was first performed in the United States in 1952 at the Wills Eye Hospital in Philadelphia. The man who pioneered this treatment was English ophthalmologist Dr. Harold Ridley, a friend of Aravind Eye Care’s visionary founder and guiding force Dr. Govindappa Venkataswamy (Dr. V). What prevented the treatment in India was simple: affordability—or lack thereof.
Each IOL lens cost roughly $100 and the entire cost of surgery was staggering; even India’s rich couldn’t afford it. The availability of the lens was limited as well and procuring licenses to import meant cutting through mountains of red tape. Yet, the incidence of cataracts in this part of the world was high and raged on unabated.
“We wondered whether we could manufacture these IOL lenses locally,” recalls Natchiar. “India needed this—it had the largest numbers of people vulnerable to cataract, many of whom were economically weak and agriculturalists. A farmer working his plow could hardly be expected to hold onto thick spectacles while doing so.”
In those initial years, Aurolab received technological support from the Seva Foundation, an American non-profit organization based in Berkeley, California. Members from Seva stayed in India for months, overseeing operations. But for Aurolab to really progress, it needed its own skilled workers.
“I come from a family of farmers. My widowed mother and grandmother made their livelihood by tending to cows in a village an hour away from Madurai,” says Nandini, 39, who has worked in Aurolab since its inception over two decades ago. “Once, many years ago, when my grandmother was admitted at Aravind for a cataract surgery, she was so impressed with the nurses she saw there. She wanted her granddaughter to be empowered like them. The minute I finished school, she urged me to apply.”
Formerly a nurse, she now supervises new trainees at Aurolab, teaching them the complex and delicate chemical process for polishing lenses during manufacturing. “In ’94, we’d just started manufacturing the single-piece lens. We struggled to make even 100 of these a day. Today, we make 10,000 lenses,” Nandini says.
Four out of five Aurolab employees are now female, from rural villages in and around Madurai. “To believe in the capability of local labor was one of the reasons behind our successful operations. “It helped us tap into a committed work force,” says Natchiar.
“As Aurolab’s success in creating Indian-made IOL’s grew, it drove the market prices down,” says Vishnu Prasad, head of international marketing at Aurolab. Lenses that previously cost $100, are now being manufactured for $1-2 with local labor and materials.
“From 2006-2009, we decided to offer our lenses to other developing nations who were in need. We were engaged in setting up dealership networks that supplied to large hospitals in developing countries. We tapped into far-flung corners of the globe,” Prasad said.
Recently, they’ve stocked NGO medical ships with Aurokits, which contain everything doctors need to perform cataract surgery in the wild. In March 2017, doctors from an Australian medical ship performed 200 sight-restoring cataract surgeries in isolated communities in Papua New Guinea.
But nowhere is the impact more clear than at home, right in the heart of Aravind hospital. Here, thousands of patients are being treated everyday with products from Aurolab’s facilities offered free of cost, or, for those who can pay, at highly subsidized rates.
People like Senthil Kumar, who thought he would never see again, and like 7-year-old Saranya, who is being treated for ptosis, otherwise known as drooping eyelid.
Several years ago, when Aravind’s Dr. Usha Kim was encountering a growing number of patients with ptosis, many of them children from disadvantaged backgrounds, she realized they could not afford the operation. “The company that made the ophthalmic material required for the surgery was practically fleecing us,” she says.
Kim sent the product to Aurolab to replicate it at a lower cost. After several attempts, the vital material now costs one tenth of its previous price.
As a result, children like Saranya can go to school without fear of being bullied for her disability.
“I can’t wait for the beginning of the new school year,” she says. “I have a lot to show my friends.”