|It is a great honor to highlight the incredible contributions of Dr. Govindappa Venkataswamy in this month's article. He was as close to a true saint as I have ever met. Our tribute is written by another one of my heroes, Richard Litwin, MD. Dr. Litwin brought the IOL revolution to both Southern India and Nepal. Like his mentor "Dr. V," Dr. Litwin has quietly been striving to improve our world and change eye care in Asia for more than 30 years. As Dr. Litwin notes in his conclusion, the spirit of Dr. V lives on at Aravind Eye Hospital, in all of us who have been influenced by him, and in the millions of patients whom he has helped. He is already missed but will not be forgotten.|
|–Geoffrey Tabin, MD, Section Editor|
Govindappa Venkataswamy, MD, the founder of the Aravind Eye Hospital in Madurai, South India, died on July 7, 2006, at the age of 87. His contributions to ophthalmology had an unprecedented impact on the delivery of modern eye care in developing countries. Last year, the doctors in the five hospitals that he built with the aid of his family and supporters from around the world performed 200,000 major eye surgeries and treated 2 million people. Most of this care was provided at little or no cost to the patient and was supported by modest fees paid by those who could. "Dr. V" was a lakh surgeon, meaning he himself had performed more than 100,000 operations.
Dr. V was born to a village family in the South Indian state of Tamil Nadu. During a stint in the Indian Army's medical corps, he developed a sharp eye for logistics that served him well later as he oversaw the expansion of the Aravind Eye Hospital. While he was in medical school, Dr. V was hospitalized for a year because he suffered from severe psoriatic arthritis, which left his hands markedly deformed (Figure 1).
Abandoning his goal of becoming an obstetrician, he took up ophthalmology, because he felt the specialty would be less physically demanding.
Several youthful interests shaped Dr. V's career. As well as participating in the movement for Indian independence (as a young man, he had met Mahatma Gandhi), he also became a devotee of Sri Aurobindo, an Indian religious teacher for whom the Aravind hospital is named. The Aurobindo group has a tranquil ashram in the former French-Indian town of Pondicherry where Dr. V spent much time in meditation. Until his retirement in 1976 at age 58, he was a professor of ophthalmology at Madurai Medical College.
Soon after his retirement, Dr. V's close-knit, well-educated, dynamic family helped him establish an 11-bed, free hospital in a private house in Madurai. Soon thereafter, the late Charles L. Schepens, MD, laid the cornerstone of the new Aravind hospital. By 1984, it had expanded to a 200-bed facility. The original building was transformed into a guesthouse that many early volunteers remember nostalgically. Dr. V's efforts at the Aravind hospital, however, were just the catalyst for a chain reaction that changed eye care in Asia.
Meeting Dr. V
I met Dr. V in 1982 when my wife Judith and I arrived at his eye camp in Pondicherry (Figure 2). I watched (and sweated in the Indian heat) while surgeons worked on the stage of a gigantic theater. Each of the eight tables was cooled by only a fan (Figure 3). Over the course of a few days, the theater's floor filled with postoperative patients.
The surgeons worked wordlessly, and the patients cooperated in silence. After the procedures were finished, women in beautiful flowing saris lay down on simple, woven straw mats, which were to be their beds for a week (Figure 4). Volunteers from local service clubs fed and cared for the patients. My wife and I were captivated by the drama and, above all, by the staff's dedication.
At the main Aravind Hospital in Madurai, I met Dr. V's younger sister, G. Natchiar, MS, DO, also a fine ophthalmic surgeon. I had brought a supply of donated Shearing IOLs (the first uniplanar PCIOL for extracapsular fixation) to the hospital. They were a new technology at Aravind. Dr. Natchiar and I implanted several of the posterior chamber lenses. The next morning, Dr. V sent for a reporter from the Daily Hindu newspaper to write about the results.
The first patient of ours to receive a PCIOL was an elderly carpenter who frightened me when we took off his patch by trying to kiss my feet. Dr. V explained that the man was delighted not only because he could see but because he could work?a very different outcome than if he had undergone intracapsular cataract extraction with 10.00D lenses. The patient could again support a family or even pay back the cost of his operation.
With Dr. V's blessing and lots of IOLs from the US, the surgeons at Aravind soon became proficient in extracapsular cataract extraction and the insertion of PCIOLs. The procedure became so popular that it was impossible to keep up with patients' demands for "spectacles in the eye." Aravind's revolutionary solution, with the help of foundations around the world, was to build Aurolab, a local factory dedicated to producing low-cost IOLs.
In 1982, a US-made IOL cost $500. A few years later, Aurolab could make a state-of-the art PMMA implant for less than $3. Today, the factory makes more than 1 million IOLs each year. They are sold in developing countries around the world and make modern treatment possible for many of the world's poor. Aurolab now manufactures sutures, viscoelastic, and many pharmaceuticals as well.
Dr. V's Enduring Influence
While I was visiting Aravind in 1982, I gave a lecture on implanting IOLs. In the audience was a young Nepali ophthalmologist, Sanduk Ruit, MD, and his future wife, a beautiful nurse named Nanda. Five years later, he and I began a series of experimental eye camps in Kathmandu to determine if we could safely implant IOLs in patients blinded by cataracts who lived in Nepal's remote mountains. I brought the supplies, and Dr. Ruit developed the techniques. The patients were delighted, and the techniques became standard at Nepali eye camps. Soon, assisted by a board of young Nepali entrepreneurs and the Fred Hollows Foundation of Australia, Dr. Ruit built Tilganga Eye Center, which is now the busiest eye hospital in Kathmandu and provides outreach activities all along the Himalayas.
In 1991, mountain climber/ophthalmologist Geoffrey Tabin, MD, joined Dr. Ruit and me at one of our camps. Dr. Tabin became passionately involved in our work and went on to form the Himalayan Cataract Project, an organization that has been instrumental in expanding Tilganga's activities into neighboring Sikkim, Bhutan, Pakistan, Tibet, China, and as far away as North Korea.
An Extraordinary Person
Dr. V's greatest strength was his ability to persuade hundreds of people from every walk of life to adopt and work toward the realization of his goals, usually for little or no pay. Although Aravind has hundreds of employees, most of them work at reduced salaries just so they can be part of Dr. V's dream. He had a clear vision of what he needed to do to eliminate blindness, one that included not only treatment but also scientific inquiry into how to bring people to eye care and vice versa. His methods were always current and most recently included telemedicine.
More than any surgeon I know, Dr. V seemed to have no ego. Once, he told me that he started every day by picturing a blind child. He never argued. He gave his opinion and then moved on. He was fixated on ending blindness.
Dr. V also took a spiritual approach to working with his colleagues and employees. Instead of berating a poorly performing manager, Dr. V called the man to his office and opened a book of Sri Aurobindos' writings. He and the manager then read aloud about the possibilities of mankind's developing a higher mind. Improvement was sure to follow.
Sometimes, Dr. V would interrupt conversations about mundane matters to discuss his latest thoughts about eliminating blindness. He was extremely simple in his life, his dress, and his food. When he was not discussing blindness, he was interested in his colleagues' lives and their children. Many is the friend who entrusted a son or daughter to Dr. V so they could experience life at the guesthouse and absorb the selfless ethos of Aravind. Sometimes, this experience came at a delicate time in the life of the child. All returned enriched. Dr. V knew suffering from his own lifelong battle with psoriatic arthritis. He knew about the highest possibilities of the human spirit from Sri Aurobindo, and about persevering to achieve one's goals from Gandhi.
My friend, teacher, and inspiration is gone. I am sad that I will no longer see his smile or hear his chuckle. Still, I am consoled to know that his life's work is in the best of hands, those of his friends and relatives who share his insights and attitudes. Aravind lives and grows through them. Long may it continue.
Richard L. Litwin, MD, practices at the Berkeley Ophthalmology Medical Group in Berkeley, California, and sits on the board of the Himalayan Cataract Project. Dr. Litwin may be reached at (510) 548-6330; email@example.com.