Getting Health on the G-8 Agenda

ROME, Italy -- Judging by the numbers of people I saw frolicking in Trevi Fountain and on the Spanish Steps as I arrived here yesterday on a sun-drenched summer afternoon, you would not think the industrialized countries of the world are in the throes of the worst economic crisis since the Great Depression. But that is exactly what will be on the minds of the heads of state of the G-8 when they come here later this week for their annual attempt to find some common ground for making the world a better place not only for the rich countries of the world, but also for the poor.

See the G-8 L'Aquila website at www.g8italia.org

And that is why I am here - - to add the voice of the Global Health Council to other representatives of civil society, largely European, to try to keep global health from getting lost in the many other pressing issues of the day, such as the recession, Iran, climate change, food security in Africa, Middle East peace and trade.

It will not be easy: In the Civil Society Meeting that begins here in Rome on Monday, immediately preceding the Summit which begins on Wednesday, health is hard to find on the agenda. The meeting is comprised entirely of four roundtables on Food, World Economy and Finance, Climate Change and something called "Public Goods" which, presumably, might include something about health. But that is not at all clear, and my job here is to ensure that global health -- and particularly reproductive, maternal and child health - get a fair hearing as access to these health areas -- and lack thereof -- have enormous effects on the poor's ability to make progress in the other areas of concern to this G-8 Summit.

Mere Rain Cannot Extinguish the Flame of Candlelight Memorial in Haiti

The opening ceremony of the 2009 International AIDS Candlelight Memorial on May 16 in front of the spectacular ruins of Sans Souci Palace in Milot, Haiti was rained out but was still a great success when it was moved to nearby Cap Haitïen, to a dinner following the event that had already been scheduled.

The festivities started when Haitian Prime Minister Michele Duvivier Pierre-Louis arrived at Cap Haitïen Airport in the afternoon and drove to Milot, about 12 kilometers away. She appeared before an enthusiastic crowd of local people at an event promoting the importance of getting tested for HIV. The rains started just before the opening ceremony and, when the rains had continued for over an hour, the program was moved to the dinner in Cap Haitien.

Abbott Fund, one of the donors of the Candlelight Memorial, announced that it was donating 500,000 rapid HIV test kits as the kick-off of a nationwide HIV testing campaign. The testing initiative is a cooperative partnership between the Haitian government, the U.S. government, the Abbott Fund and Haitian health implementing organizations.

The candle-lighting ceremony took place after the dinner, when Prime Minister Pierre-Louis and representatives of the two sponsors of the event — Vice President Kathryn Guare of the Global Health Council and Dr. Myrna Eustache of Promoteurs Objectif Zero Sida (POZ) www.pozsida.org/ — joined people living with HIV and AIDS to light the candles to remember those lost to AIDS, to advocate for improved programs and policies and to celebrate the courage of Haitians living with the disease.

Global Health Council and POZ Prepare for AIDS Candlelight Memorial Event

Five members of the Global Health Council are on the ground in northern Haiti preparing furiously for tonight’s grand opening ceremony of the 2009 International AIDS Candlelight Memorial in Milot in front of the Sans Souci Palace, a World Heritage site and the former home of King Henri Christophe between 1804 and 1820.

The Council’s main partner in organizing the event is POZ, Promoteurs Objectif Zéro Sida, a leading Haitian non-governmental organization that provides prevention and counseling services around the country. But many other governmental and non-governmental organizations are also very involved in bringing needed attention to HIV/AIDS and Haiti’s success in dealing with it.

The Council chose Haiti as the site of the opening ceremony of the world’s oldest and premier AIDS awareness raising event principally because of Haiti’s recent progress against HIV/AIDS, particularly in urban areas, and because of POZ’s outstanding record as a country coordinator of the annual event in Haiti over the last 10 years.

The activities begin this afternoon with a march that will include thousands of Haitians and culminate in a symbolic lighting of the candle this evening with a spectacularly lit Sans Souci Palace as the backdrop. Many other activities are being held today leading up to the opening ceremony including HIV counseling and testing, which also serves as the kick-off for a national testing campaign aiming to increase significantly the number of Haitians who know their HIV status.

The 2009 International AIDS Candlelight Memorial

The 2009 International AIDS Candlelight Memorial drew thousands of people to more than 1,000 memorials in 100 countries. The Global Health Council, along with the Promoteurs Objectif Zero Sida, hosted the 26th annual International AIDS Candlelight Memorial Opening Ceremony in Cap Haitian, Haiti on May 16, 2009. The Candlelight Memorial began in 1983 in San Francisco and has since spread throughout the world.

Bound by the theme of “Together, We Are The Solution,” the Candlelight Memorial reinforces our dedication to the cause of HIV/AIDS prevention and education. The Opening Ceremony highlighted Haiti's progress despite its challenges, and promoted the critical partnership between government and civil society worldwide. The event will began with a march through the town of Milot, just outside of Cap Haitian, and ended with the ceremony and lighting of the official candle.

Kathryn Guare, vice president of member resources, and David Olson, policy communications director at the Global Health Council, share their experiences of the events leading up to the opening ceremony and the event itself.


Saturday, May 16: Preparing for Candlelight
Sunday, May 17: The Candlelight Memorial

Mozambique, Cape Verde First Ladies Bring Global Health Message To Washington

Back home in the United States capital, I woke up early this morning to attend perhaps the first advocacy event since the African First Ladies Health Summit earlier this week – that being a news conference for U.S. lawmakers, implementers and media rounding up the Summit’s activities and looking forward to actions being taken by the first ladies.

Two of the first ladies who attended the summit – Mrs. Maria da Luz Guebuza of Mozambique and Mrs. Adelcia Barreto Pires of Cape Verde decided to make a stop in Washington, D.C., on their way back from Los Angeles to make sure that the summit messages were heard by all partners involved – from the donor level to the country level to civil society. The event – organized by the Global Health Council – took place at the National Press Club.

Both First Ladies through their Portuguese interpreters laid out the major health issues in their countries and how they have and plan to address them in the future. Perhaps the most important part of the news conference was the feeling by both first ladies that they were energized to build on the partnerships they worked on at the Summit to work toward real results in bettering the health of women, children and families in their countries.

The highlight of the day came from Rep. Gwen Moore, D-WI, vice-chair of the Congressional Caucus on Women’s Issues, who gave a thunderous and enthusiastic speech about the U.S. response to global health issues and on the accomplishments of the two first ladies. Rep. Moore on behalf of the Global Health Council presented the first ladies of Mozambique and Cape Verde with 2009 Global Health Awards for the first ladies’ outstanding contributions toward improving the health of people in Africa. The smiling and hugging between Rep. Moore, Mrs. Guebuza and Mrs. Pires then commenced, to the delight of those in the audience.

Wrapping up the event, the Global Health Council's very own Executive Vice President Maurice Middleberg took a couple questions answered by the first ladies. As I review in my head what I have witnessed this week – a couple of thoughts. First, these gatherings will not alone help solve the major health issues facing Africa. However, we have seen in countries such as Rwanda and Mozambique that progress on key indicators in global health is possible if there is the political and social will to do so. If the gathering of the African first ladies is properly leveraged into spirited and concrete action in their home countries, then all the glamour of Hollywood and rhetoric of Washington will be worth it for the people living in their countries. I know that the Global Health Council and civil society stands to ready to work with them.

    – Vince Blaser

Sarah Brown Brings the House Down, African First Ladies Leave Summit Spurred to Action

Los Angeles, CA.: Dr. Hajiya Turai Umaru Yar'Adua, First Lady of Nigeria, talks about a three-wheeled ambulance that was designed to aid pregnant women in remote regions of her country. Photo by Stephen Osman

There were fewer cameras and less Hollywood star power at day two of the African First Ladies Health Summit in Los Angeles, but the heavy hitters of the policy arena stepped to the stage and the summit dug deep into the major health issues facing Africa.

Sarah Brown, wife of United Kingdom Prime Minister Gordon Brown, delivered an amazing keynote in the morning – bringing the African first ladies and partners in the audience to their feet. Mrs. Brown talked passionately about the issue of maternal health. She laid out an impressive argument about how averting maternal deaths and complications are keys to achieving all of the U.N. Millennium Development Goals.

There was a palpable sense after Brown’s speech that the energy level was raised in the room. Shortly after, Her Excellency Dr. Hajiya Turai Umaru Yar’Adua, the first lady of Nigeria, took the stage and began delivering her prepared remarks for a maternal health panel. Until this speech, many of the first ladies understandably delivered their remarks exactly as written, not looking up much at the audience. While many of these speeches were very informative, they did not do much to really involve the audience.

The Nigerian first lady’s speech started in much the same manner for a couple minutes. Then, she looked up, scanned the audience, adjusted her clothes and began to speak off the cuff.  Dr. Yar’Adua began talking passionately about a project she has supported that involves distribution of small, three-wheel ambulances that can maneuver through narrow roads (and non-existent) roads to the rural areas of Nigeria. She said that many pregnant women do not go to health clinics because their husbands disallow it. But the beauty of these ambulances is that quality maternal care can come to them. The ambulance is parked in villages and pregnant women are given “mama kits” that includes supplements and information on safe maternal care. A midwife and a nurse travel with the doctor in these ambulances – which the first lady says are about one-fifth the cost of a full ambulance we see on our streets.

At the moment the First Lady’s staff finally got the pictures of the ambulances up on the video screen, and the First Lady was reinvigorated even further, I dropped any cynicism I had about the value of this Summit. The First Ladies and leaders from all sectors of the global health field came to share stories and ideas such as the three-wheel ambulance in Nigeria. Effectiveness in global health programs are correctly measured by quality data indicators, and we here in Washington D.C. are constantly pouring over them. However, I think and hope that the first ladies connected to each other with personal stories of their work and now are more motivated than before to return to their countries with an even stronger will to use their political and social power to improve health in their countries in a time of economic recession.

   – Vince Blaser

African First Ladies Convene in L.A. To Tackle Health Issues

When California First Lady Maria Shriver told a crowd of about 300 gathered in Los Angeles Monday that being a first lady is a "full-time job," the sentiment was understood all too well by a select few in the audience. The first ladies of Angola, Burkina Faso, Cameroon, Cape Verde, Republic of Congo, Lesotho, Mozambique, Namibia, Niger, Nigeria, Sierra Leone, Swaziland, Tanzania and Zambia, along with the Kenyan prime minister's wife and a delegation from Gambia traveled thousands of miles not just to walk up a Hollywood-style red carpet and mix with celebrities, but to leverage an unprecedented gathering to improve the health of the African people.

Day one of the two-day African First Ladies Health Summit hosted by U.S. Doctors for Africa and African Synergy was marked by great ceremony under an unseasonably scorching Southern Californian sun. Indeed, the mere gathering of spouses of so many African leaders under one roof with large foundations, private companies and NGOs such as the Global Health Council was a success in and of itself for a number of reasons. First, the first ladies presence in the United States in front of the national and L.A. media put the major health issues facing Africa front-and-center at a time of belt tightening around the world. Second, no matter what the tangible outcomes of the summit, the gathering will force dialogue among both the first ladies and leaders in the global health community – which should translate into more collaboration after the summit.

All that being said, day two of the summit today will be the most critical. On Monday, the First Ladies and other panelists who spoke did an excellent job of laying out the health issues in their countries and the African continent. However, the panels and sessions today will dig deeper into the issues. One such panel, co-hosted by the Global Health Council and ONE, will be examining the impact of U.S. HIV/AIDS and malaria programs on maternal health. Acting USAID Administrator Alonzo Fulgham, African Union Ambassador to the U.S. Amina Salum Ali, President's Malaria Initiative Coordinator Adm. Timothy Ziemer and Assistant U.S. Global AIDS Coordinator Michele Moloney-Kitts will I'm sure give a great overview of HIV testing for pregnant women, prevention of vertical transmission and distribution of bed nets to women. I'm hoping that the first ladies not only find this and other panels informative, but press the experts that will be on hand tomorrow on forging new and improved partnerships to tackle these major health problems and achieve the MDGs. I also am hoping the first ladies will push for joint accountability – from the first ladies to be strong champions for the health of their people and for donors to deliver on their promises in tough economic times.

Monday I was inspired because their gathering. Today, I hope to be inspired by the depth of their determination.

– Vince Blaser

For more on the Global Health Council, visit http://www.globalhealth.org/.

Photos by Stephen Osman

African First Ladies Summit

Twelve African First Ladies joined together with delegations and celebrities to address health issues in each of the First Ladies countries. From top left to bottom right: Ida Odinga wife of Kenyan prime minister, First Ladies Laraba Tandja of Niger, Penehupifo Pohamba of Namibia, Thandiwe Banda of Zambia, Maria da Luz Dai Guebuza of Mozambique, Mathato Sarah Mosisili of Lesotho, Sia Nyama Koroma of Sierra Leone, Adelcia Barreto Pires of Cape Verde, Chantal Biya of Cameroon, Ana Paula Dos Santos of Angola, Queen Inkhosikati LaMbikiza of Swaziland and Turai Umaru Yar'Adua of Nigeria. Photo by Stephen Osman


The African First Ladies Summit is being held in Los Angeles to address health-care and girls' education. First Ladies from 15 nations – Angola, Benin, Burkina Faso, Cameroon, Cape Verde, Kenya, Lesotho, Mozambique, Namibia, Niger, Nigeria, the Republic of the Congo, Sierra Leone, Tanzania and Zambia will be attending the event. The agenda includes the promotion of their work in Africa and further engagement with Hollywood and business community. The Global Health Council is one of the sponsors of this event.

Vince Blaser, the Council’s policy communications coordinator, is in LA for this momentous occasion. Read his daily blog:

Day 1: April 20 The First Ladies Convene
Day 2: April 21 Sarah Brown Brings the House Down, First Ladies Spurred to Action

Day 3: April 22 First Ladies Go To Washington

Day Six – Remote Eye Camp, Pondicherry

Rock Stars

This is it – our last day in India. Dr. Nachiar, one of the founders of Aravind, picked us up to visit the Eye Camp, an hour outside of Pondicherry. I said that it was sure to be a big turn out once they knew she would be there, but she smiled, and said no, they were coming to see us. Little did we know what she meant until we arrived. Huge printed posters in English and Tamil announced our arrival, along with thanks to the “Bill Gates Foundation” (sic). The crowd was enormous. Politicians from all corners had descended, and were all waiting for us at the gate of the local school. Much handshaking and bowing greeted us, and a massive amount of picture and video taking. We felt like big celebrities, but weren’t quite sure why.

Once the initial greeting finished, we began our tour of the Eye Camp. This town has been hosting them for more than 30 years. These monthly eye camps allow local populations to receive screening and a host of other services. It takes place at an elementary school, with the teachers and administrators serving as part of the volunteer staff. There is an almost carnival atmosphere to the event, with children playing and attendees chatting with their neighbors while they stand in line.

The flow is the same system we saw at all the hospitals, starting with registration and blood sugar tests, and moving through refractory, glaucoma screening, cataract screening, and all the other stages of the well-care eye visit. Those thinking they have a cataract come to the camp with a bag of overnight items, as they will be transported from the camp to the hospital that afternoon. Both the transport and the surgery and stay will be free of cost. Anyone found needing glasses can pick out their frames and have the glasses made right at the eye camp. They bring an extensive selection of lens strengths, along with frame styles to the camp. There are also prescription eye medications available, if needed.

After our tour of the Eye Camp, we were seated on a dais for a short program in our honor. Many speeches followed, including one from the local businessman who started it all 30 years ago. He has nine children, and began his philanthropy when he was poor. Now his adult children help sponsor the monthly eye camps, and are all highly-respected members of the community. The visit ended with a lovely ceremony where we were all given gifts. We then had our pictures taken with some of the recipients of hand-cycles donated by the same family trust.

Pottu Varan
Back to Pondicherry for lunch, and then our last ride to Chennai to meet our planes. Our driver took us on a different road this time, one that winds along the coast. We passed vast salt fields, and areas affected by the tsunami. We also drove close to the temples of Mahabalipuram, an extensive archeological dig that unearthed a series of shrines carved out of the living rock more than 1,200 years ago.

We arrived in Chennai and said our goodbyes, both to each other, and to India. We all experienced an incredible organization in action, along with the background culture that has formed Aravind. What an amazing trip.

Pottu varan (“Goodbye” in Tamil) –
Dawn

Day Five – Auroville and Aurobindo Ashram

Today was a bit of a departure for our group. Instead of looking to the physical and organizational backbone of Aravind, we explored some of its philosophical underpinnings. Aravind’s founder, Dr. Venkataswamy, was a follower of the scholar and spiritual guru, Sri Aurobindo. His teachings, and those of the Mother, one of his followers, were an ever-present guidepost for Dr. V in his pursuit of a more effective health system for eye care.

Our first visit was to Auroville, the Utopian realm envisioned by the philosophers. About 2,000 people live there now – approximately 1,500 adults and 500 children. Through a national mandate, residents of Auroville are not considered residents of India. Rather, they retain citizenship of their home countries. Auroville’s residents work in the community where all is provided for in exchange for a percentage of their income. Everyone there is focused on change: spiritual, global and internal.

After watching the video describing Auroville and its goals, two of its residents gave us a tour of their community. We visited a newly-built clinic, devoted to working with all types of medical treatment including traditional, ayurvedic, homeopathic and more. The doctor in charge is from Kazakhstan, and already has a number of practioners of various forms of healing on staff. We then had lunch with our hosts in their solar-powered Community Kitchen.

Later that afternoon, we visited the Sri Aurobindo Ashram in downtown Pondicherry where both the Sri Aurobindo and the Mother lived and are now enshrined.

After a bit of shopping, some of us walked along the Indian Ocean beach, stopping to admire the statue of Gandhi. Having the opportunity to explore the spiritual background of this amazing organization and country is tremendous. It gives me just a bit more insight into the incredibly altruistic actions of the leadership team. Tomorrow is our last day in India, and we will be closing with a bang – an eye camp in a village known for its cashews and longevity of service to Aravind.

Goodnight,
Dawn

Day Four – Pondicherry Hospital, Pondicherry

We gathered for our morning flight to Chennai (old Madras), where we were met by Aravind staff from the Pondicherry Hospital. Pondicherry is the most recently built of the five main Aravind base hospitals. Where the physical plant of Aravind Madurai was expanded as resources and demand grew, Pondicherry sprang fully-formed from the architect’s pen.

Situated on 70 acres just outside of the city, the campus includes two large residential areas that house not only the sisters that work at the hospital, but also many of the doctors and their families. This beautiful building is an engineering marvel. Many systems found in the other hospitals are found here, but it is also host to many new innovations. One of the most exciting is the water reclamation system. All sewage water goes into a series of celled cisterns, and left to sit for a certain period of time after which a mixture of aerobic and anaerobic bacteria is created. Through a series of containment and flow through rocks, the end result is water at the highest level of purity.

The central section of the main hospital building houses the operating theaters and specialty clinics. As you walk in, you are greeted with a beautiful open space in the middle of the building with lush plantings and statuary. The buildings on either side house the post-op recovery accommodations. The free side is on the left, with spacious rooms for mats or cots, and eating areas. The paying side is a bit more posh, with private and semi-private rooms. Again, the patient makes the choice of which side they will register. The eye wear “store” is huge, and replete with every kind of lens and frame design – all manufactured and fitted in-house.

The tour wends it way through the surgery areas, much bigger than anything we saw in Madurai. Many rooms are still unused, showing the main difference between the first and latest hospitals: Madurai is crowded, and always trying to squeeze more out of its space, whereas Pondicherry is looking to DOUBLE its present patient load before it starts to outgrow its space.

After a long afternoon of touring, we head back to our hotel and dine under the stars, overlooking the Indian Ocean. Just lovely.

Falling asleep, listening to the waves,
Dawn

Day Three – Free Hospital and Vision Center, Madurai

Apologies for the delay in posts as the internet connection here in India can, at times, be scarce. But back to the study tour…

Known as the Temple Town, Madurai boasts a series of 13 temples from different periods in Tamil Nadu history, and is the most famous of all temple areas in southern India.

Vision Center
We began our day with a short drive out of the city to the village of Alanganalure, which is known for its Bull Taming festival and the fierceness of the women from this region. Our focus was seemingly a bit more mundane, however, as we went to visit one of Aravind’s 37 vision centers in South India. Each of these centers is connected to one of five base hospitals. This one, for example, is connected to the one we visited in Madurai yesterday. Through a program with the U.C. Berkeley and Intel, they have a fixed point broadband system – with the vision centers at one end, and the base hospital at the other.

It was amazing to see this system in action. A doctor at the base hospital works with anywhere from five to 12 vision centers. The patient form the local village comes in to the vision center for a scheduled appointment, surgical follow-up or other eye issue. The vision center is staffed by two of the sisters – one who is responsible for the registration, patient flow and refractory products, and another who carries out the eye examination. Many of the same ophthalmologic tools in the hospital are in this facility – really an old shop-front about 10 feet wide and 30 feet deep. She will perform the routine tests of blood pressue, eye pressure, blood sugar, refraction, and fundus imaging, etc., right here, then connect with the doctor at the base hospital. This telemedicine technique is revolutionary as people unable to make the journey to the city can still talk “face-to-face” with the doctor, who has just received the test result for the patient electronically. The consultation takes place directly, and any medicines or corrective eye wear can be obtained immediately at the facility. Any surgical recommendations can be acted on as soon as the patient is ready to go to the hospital. The sisters are from the village, so have a good relationship with the patients, resulting in an experience that may be less intimidating than a hospital visit.

Besides the two sisters at the vision center, there are two field workers who are responsible for seeing one-half of the covered population (about 50,000) each year. Their task is to visit each house, and screen the vision of the inhabitants. They also encourage older residents to come in for annual glaucoma exam to decrease the effect of this disease. Because the loss of peripheral vision is so slow, a person with glaucoma may have no idea that their vision is decreasing until it is too late.

Free Hospital
After lunch, we set out for the Free Hospital at Aravind. Other Aravind hospitals around Tamil Nadu were built with free on one side, and paying on the other, and the surgery and specialty areas in between. Aravind Madurai started as an 11-bed hospital, and has grown in fits and spurts, adding space as needed. Because of that, the Free Hospital is on a separate campus, around the block from the Paying Hospital. Unlike in U.S. where free care only follows massive amounts of qualifying paperwork, the patients at Aravind select the hospital in which they are seen. There is a perception that if it costs more, it must be better, and that drives many families to sell a cow or take out a loan to afford treatment at the Paying side. Aravind does nothing to dispel this myth, as it keeps people more honest about their ability to pay. The interesting thing is that the care at Aravind hospitals do not differ at all, with the staff cycling though both hospitals during the week. The main difference is the accommodations. Instead of a private suite with one’s own bathroom, the Free Hospital offers mats on the floor or cots. This concept of choice also extends to the type of intraocular lens the patient selects.

A Little Sightseeing – Meenakshi Temple
After a reluctant goodbye to the Aravind staff, we headed back downtown to the Meenakshi Temple, tallest of the 13 in the city. We were hosted by two of the city’s leading authorities, and spent the afternoon exploring the beautiful stone interiors dating back thousands of years. This temple was built to honor Meenakshi, one of the forms of Shiva’s consort. She is Vishnu’s sister, and symbolizes the peaceful coexistence of the two lines of followers of Shiva and Vishnu. Some people believe it is why there is comparatively little religious conflict in the area. The story is that Shiva rode into town on his bull, and married the feisty goddess, making her submit (eyes down, etc.) before the marriage. When they were officially joined, the tables turned, and he submitted to her. On the occasion of the marriage, the streets flowed with milk and honey. We saw the Temple elephant being walked for his health, and the “People Tree” where women hang cradles in amongst the leaves and pray to have children.

All packed up, but sad to be leaving this land of milk and honey and the birthplace of Aravind. Tomorrow, we fly back to Chennai, and drive south from there to Pondicherry (Puducherry), an old French colony by the sea.

Dreaming of Madurai,
Dawn

Day Two – McSurgeries, Madurai

What an incredible day! Day Two started off early so that we could observe a few eye surgeries. Study tour participants requested this addendum upon hearing more about Aravind’s efficient methods inspired by the McDonald’s assembly-line. Last year alone, Aravid performed 280,000 surgeries.

The first surgeries we saw were the cataract removal, Aravind’s signature procedure. Each operating theater has four beds and two surgeons. Each surgeon is stationed between two operating tables with one microscope. The apparatus swivels between, allowing the surgeon to switch between the two areas easily. The patient is led into the room, and prepped by the surgical team, comprised of trained sisters.

The surgeon deftly makes a small millimeter slit in the cornea, and inserts a surgical probe. After tearing a small hole in the sac surrounding the lens, she inserts a small ultrasound tool and proceeds to shatter the lens. She aspirates the lens bits out, and inserts the folded flexible replacement lens. With such a small incision, no suture is needed. The whole process took about 6 minutes. When she finishes, she replaces her surgical gloves and begins on the other table, with a new patient, clean tools, and different cataract. With this highly efficient process, a good surgeon will complete more than 30 surgeries in a day. The speed and grace of the surgical staff was wonderful to watch.

A Hospital
Next was our tour of one of Aravind’s Hospitals, following the same path as a patient would on a visit. We started in registration where a phalanx of sisters ran the intake area with an amazing smoothness, considering almost every patient is a walk-in. Aravind’s complex record keeping allows them to predict patient flows with a better than 0.5% accuracy, taking into account festival days, holidays, auspicious days and a myriad of other factors. Everywhere you see matrices showing the expected levels for the different surgeries, consultations and other services they provide.

Our tour continued through the pre-op areas where the patient is screened and monitored. After these metrics are recorded, the patient will meet with a doctor. There are not that many doctors, so the consultation lasts a very short time, consisting mostly of a diagnosis. The patient is then assigned a counselor who will spend a much longer period of time with each patient, going over the different treatment options, costs, recovery times and other follow-up issues.

We then moved upstairs to visit most of the specialty areas: glaucoma, diabetic retinopathy, low vision, uvea function and more. The areas were seemingly chaotic, but the time between registering and moving to your next area was very short. Aravind is also piloting a program where a patient is issued a card upon entering that will be embedded with a small microchip. Sensors in the building will chart the progress of the patient, and help forecast any sudden staffing or equipment needs. We also visited the research area where studies involving the Indian eye population are being carried out.

Aurolab
After lunch, we traveled to outskirts of Madurai where the Aurolab facility is located. Begun as a low-cost manufacturing alternative, Aurolab first developed a $10 intraocular lens when most lenses in the world were costing around $150. They now manufacture a wide array of lenses, along with ophthalmic pharmaceuticals, surgical blades, supplies and instruments. The level of cleanliness meets every standard in the world, including the FDA, but not all products are approved for use in the United States. Behind Aurolab is the new Aurofarm, an organic farm just recently started with the hopes of producing vegetables and providing a recreational area for the staff of Aravind. The layout is truly lovely, and includes a quarry pond, in-ground swimming pool and garden for their use.

Dinner included a program of indigenous folk dancing, including karagaattam, a dance where the dancer balances a pot on their head while balancing on a wooden ball, and silambattam, where the male dancers fight with long wooden sticks. The women also performed, including a version of the snake dance. The whole event took place next to a pool of water so smooth that it looked as if the dancer and her image were partners in the performance. Magical.

Tomorrow is our last full day in Madurai, and will include a trip to a vision center in the rural area outside of the city.

Until then,
Dawn

Day One – Aravind Hospitals, Madurai

The study tour begins with a trip to LAICO, the Lions Aravind Institute of Community Ophthalmology. Our group is met by LAICO staff with glorious garlands of aromatic jasmine and cedar. Madurai is world famous for its jasmine, especially for the single garlands, malligi, usually worn daily by local women. The scent is intoxicating, and the welcoming ceremony, moving.

The staff, led by Aravind Chair Dr. P. Namperumalsamy (Dr. Nam), began an overview of Aravind Eye Care System. The detailed presentation outlined not only the surgical/medical excellence the organization is known for, but also highlighted the other facets of their success – commitment to serving everyone in pursuit of eliminating needless blindness, and an incredible knack for business management. This illustrated the scope and efficiency of Aravind, and gave a preview of what the study tour will witness in the coming days.

After lunch, study tour participants heard from the division of AECS, the LAICO education structure. Starting with a tour of the building, they addressed how their teaching facility not only served their internal needs for training medical and support staff, but also the greater ophthalmologic community. Students and practitioners from around the world descend on Aravind daily to take advantage of educational programs. The subjects range from eye care, to professional and managerial development, to global partnership opportunities.

During the tour, they introduced our STPs to the concept of Aravind “sisters.” These young women are recruited right out of high school from the rural areas surrounding Madurai. They spend one year of residence, training to work with patients, and are usually chosen to serve as patient counselors. After two years, they are ready to assist patients in navigating the world of eye medicine by explaining the surgical options available to them, accompany them during the surgery, explain in detail the correct post-operative care procedures, and encourage them to return for follow-up in four to six weeks. As most of the patients come from the same rural areas the girls hail from, working with them helps to dispel much of the trepidation that may come with visiting the hospital. This increases the likelihood of a successful procedure, and the girls have an opportunity not usually available to them in their villages. My hope is that the financial and educational independence they gain will ensure a better fate for their own girls.

After a day full of new information and new acquaintances, dinner featured some friends of Aravind – NGO partners and local industrialists, all vitally interested in the success of Aravind. Tomorrow will be an early morning, with the study tour joining the doctors in the operating theatre.

Eravu Vanakkangal (“Good Night” in Tamil)
Dawn

2008 Gates Award Study Tour

The Global Health Council is hosting a study tour of influential global health leaders from around the world to learn about the work of 2008 Gates Award for Global Health recipient, Aravind Eye Care System. Aravind received the award in recognition of its groundbreaking work to prevent debilitating blindness and provide affordable, world-class eye care to the poor. Based in Tamil Nadu, India, Aravind provides an integrated approach to the provision of eye care services to a large population in southern India and has established a new model of financial self-sustainability.

Study Tour Participants:

Dr. Mulu Admasu, Chief of Eye Surgery, ALERT Hospital, Ethiopian Ministry of Health
Dr. Ponni Subbiah, Vice President and Head, Global Access Strategy, Pfizer Inc.
Dr. Suzanne Gilbert, Director, Center for Innovation in Eye Care, Seva Foundation
Fred de Sam Lazaro, Global Health Correspondent, NewsHour with Jim Lehrer
Maurice Middleberg, Executive Vice President, Global Health Council
Dawn Ellen Carey, Awards Program Coordinator, Global Health Council
Jim Wiggins, Independent Consultant

Join Dawn Carey, awards coordinator at the Global Health Council, and follow the Study Tour’s journey through Madurai and Pondicherry daily, as it happens.

Madurai
Day 1 – Aravind hospital sites
Day 2 – Surgeries, Hospital and Aurolab
Day 3 – Aravind Free Hospital and Remote Vision Center

Pondicherry
Day 4 – Pondicherry Hospital
Day 5 – Auroville and Aurobindo Ashram
Day 6 - Remote Eye Camp