The magic of social enterprise

It is easy to get overwhelmed, even depressed, by statistics that tell a dark tale about India's millions living miserable lives. Rural India has been left far behind in India's story of growth and development, oft trumpeted from international platforms. Undoubtedly, urban India rules the roost; the importance of activism that can electrify the urban middle-class was driven home by Anna Hazare recently during the Lokpal Bill saga.

But while the brave talk vis-à-vis corruption is still very much at the theory stage, there are many real, and unsung, initiatives happening at the ground level across the country. One of these pertains to the Sankara Eye Care Institutions headquartered in Coimbatore and run by its founder and managing trustee, Dr R.V. Ramani.

The objective of this social entrepreneur's 35-year honorary service is to bring quality vision care to the poor and underprivileged, especially in rural India. The phenomenal work done by his team of doctors, with the supporting zeal and commitment of the local communities, has resulted in the screening of millions of people in rural India, over 10,000 weekends, for eye ailments or vision defects.

These doctors perform 500 free eye surgeries a day, 70 per cent of which are cataracts, at its various hospitals, including 200 a day at the headquarters in Coimbatore. From 1990 onwards, 9 lakh free operations have been done by the Sankara hospitals, which were set up at the behest of the Kanchi Kamakoti Mutt's Sankaracharya. The first of the Sankara eye hospitals was set up in Coimbatore in 1977, a year before the famous Sankara Nethralaya in Chennai. “But because we are not in a metro like Chennai or Delhi and only in a ‘mofussil' area like Coimbatore, nobody talks about us”, says the quiet and genial doctor.

Surprisingly, this 5-acre facility, where 20 per cent of paid patients pay for the free treatment that 80 per cent of the poor receive, is a spanking clean and lush green hospital. Forget litter or smell, there are no bits of paper or even a stray polythene bag lying around.

Rural focus

Explaining the rural focus of this enterprise, Dr Ramani says that he wanted to reach quality eye-care to rural India “but I didn't want it to be a one-day mela. So we identify a cluster of 10 villages, and partner with some local women and youth, who help with the initial health survey of the villagers.”

Out of 10,000 about 600-700 have some visual impairment and are given Gift of Vision cards. Eight weeks later, on a Sunday, a team of doctors and paramedics from the nearest Sankara centre drives to the villages, examines the patients and those requiring surgery are brought to the main hospital “in our vehicles. They are investigated, transported, accommodated, operated on and given food. He adds that even though the paying patients have a separate wing, where the rooms are air-conditioned, there is no difference in the quality of surgical and medical care given to the poor. “We do state of the art, sutureless phaco surgery with IOL implants. The actual cost of a cataract with IOL is Rs 2,750 because we do huge volumes. We implant high-quality lenses made in Chennai.”

Though after cataract surgery patients these days can be discharged in an hour, “we send them home only the next day, after changing three bandages. We might give them quality surgery here — 10 surgeries can be done at a time in one OT — but they don't live in a very clean environment.”

The reality of a poor and rural India is access to transport and for the Sankara patients, this is a double-whammy as most of them are elderly people. In our march to compete with the ethos and practices of the “developed” western world, we too are becoming increasingly callous about caring for the elderly. So the Sankara team goes to the patients on the 5th and 30th days after surgery for follow-up of the operated cases.

But having covered the health and medical beat for long years in my 33-year career in journalism, and being told umpteen times about the “free medical care” our hospitals give to the poor, there was more to be impressed by in this story than the sheer volume of the work.

Vision scores over numbers

Apart from the impressive numbers, such as 500 free surgeries in a day, this social entrepreneur is to be admired for his vision. He has not only replicated the Coimbatore model in eight centres in Gujarat, Andhra Pradesh, Karnataka, and Punjab, apart from Tamil Nadu, but equips the local youth from villages with excellent technical skills.

When Ludhiana was chosen for setting up the Punjab hospital, “we interviewed 100 girls with Plus Two qualification, from the surrounding villages, selected 40, gave them two months of spoken English classes in Ludhiana and brought them here to Coimbatore to be trained as certified vision-care technicians,” said Dr Ramani.

These girls are taught surgical theatre techniques, optometry, OP assistance, etc. Forget capitation fees, there is no tuition fee; and the girls get a stipend of Rs 2,000 and Rs 3,000 in the two years so the “parents are not strained.” The accommodation is free, the food subsidised. Once the hospital building is ready, they are ready to be employed at a salary of Rs 6,000. Similarly, he trains eye doctors from the region so that there is a regional, language and cultural match.

Imagine the ripple effect in rural economies caused by such initiatives that give villagers an income option other than agriculture.

Small wonder that others were enthused to follow Dr Ramani's lead. Sankara's CEO, Mr C.N.Srinivasan, is a qualified chartered accountant, and after doing free internal audit of the institution for 25 years, handed over his very successful firm to his juniors when he turned 50. “He now works full-time for us — from 9 to 7 — for zero salary, and has helped us introduce systems and processes,” says a grateful Dr Ramani.

Such endeavours and examples restore your faith in human beings!

( blfeedback@thehindu.co.in and rasheeda@thehindu.co.in )

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