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“The Poor Should Not Be Treated Poorly”
By Shlomo Maital
From left to right: N. Ankalamma,(mother of Chennamma), Chennamma (patient), Mr Thirumla Kondalu & Mr Karunakar (Community Based Field Staff who counselled her at her home) and Dr Nilesh Jaiswal (Ophthalmologist who performed the surgeries at the secondary centre).
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I’ve just returned from a short trip to Hyderabad, India, where I and my co-author Prof. D.V.R. Seshadri launched our new book Smartonomics (SAGE India). While there, Seshadri and I visited the L V Prasad Eye Institute, which has treated 21 million patients since it was founded 30 years ago by Dr. G. N. Rao. We are writing a Case Study about LVPEI.
Here in brief is the story. Dr. Rao and his wife Prattibha lived in Rochester, New York, in 1986. Dr. Rao had a comfortable prestigious position at the University Hospital there, as a top ophthalmologist. But he and his wife chose to return to their homeland, India, to found a world-class eye disease institute. A famous film producer L V Prasad donated the money for the land and building, in Hyderabad.
Dr. Rao’s vision was to provide excellent world-class eye care for all, including those who could not pay. How? Cross-subsidization. Those who could pay, would. Those who couldn’t, would not. And somehow the resources would make possible truly excellent innovative eye care, restoring vision for many many thousands. LVPEI began in 1987 with three examination rooms and 2 operating rooms, and soon expanded into 4 states, with primary, secondary and tertiary eye care reaching into the poorest rural regions.
Dr. Rao implemented his vision of the four E’s: excellence, efficiency, equity and empathic eye care. He expressed it as an Eye Health Pyramid (see figure):
In this model, state of the art eye care was provided at the LVPEI center in Hyderabad, India’s 6th largest city. Secondary and primary eye care was pushed out to the periphery, always under the watchful eye and supervision of the LVPEI center. In the past 3 decades, 21 million people have been treated. Many have had vision restored. There is no greater gift.
This model is crucial, because however excellent, the Eye Care Center in Hyderabad is of little value for the rural poor, unless there is outreach and counselling that identifies their problems and begins to treat them. All too often, health care available in big cities is far superior to that available in the poor rural regions.
Here is just one small story: Nalagati Venkata Chennamma was born with visual and intellectual impairment. At the age of 8, her vision deteriorated further. Fearing high fees and Chennamma’s difficult behaviour, doctors were never consulted by the family. At the age of 20 she underwent an eye check and was declared 100% blind. But as fate would have it, five years later, Karunakar one of LVPEI’s Field Rehabilitation Service Officers visited her and spotted symptoms of cataract. Apprehensive in the beginning, Chennamma’s mother brought her to LVPEI’s secondary centre in Markapuram on 7th November 2016. She was operated by Dr Nilesh Jaiswal for congenital cataract in both of her eyes and subsequently regained functional vision. There is a possibility that her vision can be further enhanced and she is currently undergoing treatment at LVPEI’s Hyderabad Centre of Excellence Campus. Today, her family is delighted with the outcome of the surgery and are thankful to LVPEI and its talented doctors. There is hope that with vision restored, Chennamma can make up some ground in her intellectual development.
Dr. Rao has just been selected for the American Society of Cataract and Refractive Surgery (ASCRS)’s Ophthalmology Hall Of Fame, a rare honor given to very few. He will travel to the Los Angeles for the induction ceremony on May 6.