Thursday, February 19, 2009
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.
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.
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.