Vision In Practice: A Humanitarian Commercial Enterprise Fostering the “Gift of Sight” Adapting the Aravind model of high-quality, high-volume, low-cost surgery in rural China
Jun 14, 2015
Vision In Practice: A Humanitarian Commercial Enterprise
Fostering the “Gift of Sight”Adapting the Aravind model of high-quality, high-volume, low-cost surgery in rural China
China Blindness Data
✤ Total number of blind people: 6.6 million (2011 estimate)
✤ Total number of visually impaired people: 13 million (2011 estimate)
✤ National blindness prevalence: 0.5% (2006 estimate)
✤ Leading causes of blindness: cataract, diabetic retinopathy, corneal disease, glaucoma
✤ Cataract surgical rate: 800 (2010 estimate)
The Standouts: China and India
Vision in Practice: Our Mission
Vision in Practice strives to eliminate needless blindness in China (and beyond)
by providing doctors and support staff with the clinical and surgical training, business skills,
resources and networks they need to build, operate and expand
high-quality, high-volume and financially sustainable eye care practices in any community
regardless of patients’ ability to pay.
Cataract surgery training at AravindSince 2008, organized training in India of 50+ Chinese surgeons in ECCE, SICS, phaco
What awaits these surgeons upon their return to China?
✤ Limited access to surgical opportunities, despite training
✤ Temptation to “moonlight” outside on nights, weekends
✤ Continuing low salaries due to “monopoly” of senior surgeons
✤ Collapsing morale, temptation to abandon medical practice for industry jobs
An Aravind-Inspired Workplace
✤ Demand generation: Intense focus on rural screening camps
✤ Capacity building: Training, retraining and recruitment to meet newly generated demand
✤ Safety is paramount: Low rate of complications best assured by staff empowerment, high skills and accountability
✤ Services with dignity: Treat patients as if they were kin
✤ Cost recovery: Premium subsidizes low-cost surgeries
✤ Reimbursement: Multiple sources of revenue capture
✤ Nothing is “free”: Standard Surgery provided at “no cost to the patient”, but optional upgrades help drive revenue
✤ Patient counseling: Even the poor can make intelligent, informed decisions
Prototype: Tancheng Xinyimin HospitalFounded in 2009 by local Tancheng County ophthalmologist Dr Tian Zuolong
Dr Tian Zuolong
Inspired by Aravind in Dr Ramakrishnan’s 2005 lecture at COOC ShanghaiTrained in SICS by Dr Hao Xiaojun following Hao’s 2-year fellowship at AravindFounded Xinyimin Hospital in 2009, determined to embrace the Aravind model Without screening and using only SICS, has restored sight in 1,000+ walk-in patientsIn 2011, joined with Vision in Practice to redeploy Xinyimin as demonstration hospital
Dr Hao Xiaojun
First read about Aravind in Chinese edition of Ophthalmology World Report in 2003In 2004, selected as first Chinese trainee as Dr Venkataswamy demanded a China strategyIn 2006, became the first international doctor to undertake a 2-year fellowship at AravindSince 2008 has experimented with “screen-to-surgery” model in Hangzhou and GuiyangCo-founded Vision in Practice in 2009, serving as Medical DirectorCo-leading ViP’s overhaul of China’s top residency program at Fudan University/EENT
Dr May Khadem
Faculty ophthalmologist at Northwestern University, and veteran anti-blindness activist Decades of experience as cataract surgeon and surgical trainer in many countriesDeployed to China in 2010 with a personal mission to tackle barriers to quality eye care Joined Vision in Practice in 2011 as Director of ProgramsLeading ViP’s overhaul of China’s top residency program at Fudan University/EENT
Jeffrey Parker
Veteran journalist and media executive based in China since 1990Founding editor of China and India editions of Ophthalmology World ReportIn 2007, bridged Chinese and Indian ophthalmologists with surgical training exchangeFounded Vision in Practice in 2009 to foster better venues of practice for Aravind traineesAs ViP’s Executive Director, strives to match resources with opportunity and acute need
Xinyimin gets a facelift
Three days of intensive training
Redeployment, division of labor
Role playing, team building....
Text
Discussion and planning...
All together now: Screening as a joyous team effort
Outreach in the open airDespite only one day’s notice, 86 villagers turn out for county’s first free screening
Logistical challenges of poor, rural patients
✤ 88 years old, with operable cataract in both eyes
✤ Lives alone with no phone, doesn’t know her own address
✤ Hobbled to screening on feet that were bound in her youth
✤ Keen for free screening, walked 1 hour from another village
Camp Metrics
✤ Screened villagers range from infants to nonagenarians
✤ Screening differs widely: many ailments, wide demographics
✤ Nearly 1 in 3 presents with serious cataracts, most with at least one operable eye
✤ Many have no means to travel to hospital or district town
Reaching the unreached
Daily screenings, Saturday surgery
✤ Villagers screened in 21 weeks: 3,671
✤ Cataract candidates found: 1,047 (29%)
✤ Procedures performed: 269 (26%)
✤ Treated at no charge: 134 (50%)
✤ Opted for paid upgrades: 135 (50%)
✤ Selected phaco at 2,599 RMB: 13 (5%)
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21-week financials
✤ Total cost (RMB) 265,806
✤ Paid upgrade revenue 144,465
Imported IOL (85 @ 599) 50,915Heparin IOL (28 @ 1,799) 50,372Phaco/foldable (13 @ 2,599) 33,787
✤ Surplus (loss) (121,341)
✤ If insurance @ 800/eye* 215,200
✤ “Potential surplus” 93,859
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Happy patients,happy staff,
happy donors
Vision in Practice Objectives
✤ Provide access to high-quality, hands-on surgical training that remains virtually unavailable in China
✤ Provide management consulting/coaching to cultivate a dynamic, efficient workplace marked by teamwork, smart division of labor
✤ Provide empowerment training to nurses, technicians, marketing, logistics, finance and other non-physician staff to optimize efficiency
✤ Comprehensive community outreach training to accelerate demand
✤ Facilitate access to insurance reimbursement, grants, investment, loans and other financing to achieve sustainability/profitability
Vision in Practice priming the pump: Quality flows to all, regardless of
ability to pay