By 1976 Dr. V (as he came to be known) had performed over 100,000 sight restoring surgeries. That same year, he retired from government service at the age of 58, and founded Aravind, an 11-bed eye clinic in south India. No money. No business plan. No safety net. Over the next four decades his humble clinic would defy the odds to become the largest provider of eye care on the planet.
If you can’t come to them, they will come to you. If you can’t pay them, you don’t have to. Aravind has now treated over 55 million patients and performed over 6.8 million sight restoring surgeries. The majority are treated free or at steeply subsidized rates.
And yet, Aravind is a self-sustaining organization. Serving everyone from penniless farmers to the president, it delivers world-class outcomes at a hundredth of what similar services cost providers in advanced nations. Hundreds of organizations around the world, from Rwanda to San Francisco, are seeking to replicate its model.
This is an organization that chose to rip the price tag off a sight restoring surgery, steer clear of fund-raising, and market to the people who couldn’t pay them. At the core of Aravind’s baffling success are radical principles and profound insights. They speak to the heart of Dr. V’s selfless vision and demonstrate how choices that seem quixotic, can, when executed with compassion and integrity, yield incredible results. Results that have lit the eyes of millions.
Dr. V passed away in 2006, but his vision lives on through the work of Aravind and its 4000 person team, that today includes over 25 eye surgeons across three generations of Dr. V's family.
The following are edited excerpts from Infinite Vision: How Aravind Became The World’s Greatest Business Ca..., by Pavithra Mehta and Suchitra Shenoy (Berrett Koehler, 2011) that shine a light into the heart and mind of this extraordinary visionary.
When People Need Help You Say I Will Help You
In an interview with Aravind’s founder, questions shoot out like impatient arrows from Justin Huggler, Asia correspondent for the British newspaper The Independent: “How? How did you do it all? How do you keep on keeping on the way you do? How do you persuade so many others to do the same?”
Dr. V, who can sometimes be very somber during interviews, is at his sunniest. He smiles and says nothing. “How did you manage to do it all, Dr. V?” Huggler persists, and Dr. V chortles. “You know, there are people who have climbed Mount Everest,” he says in his strongly accented English. When you spend some time with Dr. V, you eventually begin to understand his seemingly irrelevant answers to questions that refer too closely to the grandeur of his achievements.
But this is Huggler’s first meeting with Dr. V, so he tries again. “Yes, but it takes people four weeks to climb Everest, and then they go home and holiday. You’ve been doing this work day after day after day—how do you do it?”
“People are good at heart; they help you.”
“Maybe, but they’re also lazy. How did you make this to work?” Huggler is determined to get somewhere. And after a few more digressions on Everest, unexpectedly he does.
“You see, when people need help, you can’t simply run away, no?” says Dr. V. “You say, I will help you, and then you do what you can.
Even when we started, we did good-quality work, so the rich people came and paid us, and we could treat the poor people with the money saved. The poor people brought more poor people; the rich people brought more rich people. So now, here we are.”
The man has fit his entire life’s work and the evolution of the largest eye care system in the world into five sentences.
Huggler laughs, and his face relaxes for the first time. “Amazing,” he says, “this is just amazing.” His wonder is still laced with a journalist’s curiosity. “But what motivates people to stay and work so hard here when they could have things so much easier somewhere else?” “What motivates people to climb mountains?” asks Dr. V in return. “It isn’t easy to climb Everest, but people do it anyway—isn’t it?”
You’re Entitled to the Work. You’re Not Entitled to the Results
“You see McDonalds’ concept is simple. They feel they can train people all over the world, irrespective of different religions, cultures all those things, to produce a product in the same way and deliver it in the same manner in hundreds of places. Supposing I am able to produce eye care, techniques, methods the same way and make it available in every corner of the world... (then) the problem of blindness is gone!” - Dr. V
“I was teaching international health at the University of Michigan. Dr. V came to my office, and when he talked about eliminating blindness, you got the feeling that this man was either a saintor a complete nut. He kept talking about McDonald’s and hamburgers, and none of it made any sense to us.” Dr. Larry Brilliant’s voice ripples with laughter before turning serious. “But as you began to understand what he had already done in life, he moved you beyond imagining.”
For the hundreds who would step forward to work alongside the Aravind team, one of the compelling aspects of the partnership was bearing witness to a visionary whose driving force was a spirituality firmly anchored in practical action. “The Bhagavad Gita says you’re entitled to the work; you’re not entitled to the results. You’re not entitled to the fruits, the successes, rewards, the name, the fame, the money, the power. And Dr. V embodies that approach.
He takes nothing and wants nothing for himself,” says Brilliant. “He is a spiritual warrior as much as an ophthalmologist. But he doesn’t then just stop and say, ‘I am a spiritual warrior, so we don’t need to have the best infrastructure, we will just wave our hands around.’ He brings in the best
techniques, the best equipment, and builds cutting-edge infrastructure because he is so practical. It’s an unbeatable combination.”
Larry Brilliant successfully led the smallpox eradication program in India, its last outpost in the world. Through Seva Foundation (non-profit of which he and Dr. V are both founding members), he has a long-standing relationship with Aravind.
Widen Your Consciousness and Feel the Suffering of Others
In 1980 Dr. V would write in his journal, To some of us bringing divine consciousness to our daily activities is the Goal. The Hospital work gives an opportunity for this spiritual growth. In your growth you widen your consciousness and you feel the suffering of others in you. He frequently refers to this concept of divinity and approaching the divine through work.
Jacqueline Novogratz, the dynamic founder of the Acumen Fund, once asked Dr. V directly about his conception of God, “He told me that for him, God existed in the place where all beings were interconnected,” she writes, “He was able to fuse the power of an unsentimental approach to treating poor people in the most effective way, with the moral imagination to see people, really see them, and listen to their needs and dreams. In this way, I think he saw godliness and beauty in all people and all things.” Dr. V’s quest to eliminate blindness was fueled by this view of humanity and by his deep empathy for the suffering that blindness inflicted on people – and particularly on the poor.
Get Less, Do More
Ever since the early 1990s, Aravind’s doctors have been compensated at roughly the market rate. But during the first decade, money was desperately tight, and the founding team drew dismal wages. “I used to secretly complain to Fred Munson [longtime volunteer and an old friend of the family’s] about how tough it was,” recalls Natchiar, breaking into laughter.
“With his help, we finally got a raise in the late 1980s!” They would all struggle to rear their families in the midst of the unrelenting toil of those years. Viji stationed a crib outside the operating room and nursed her ten-day-old son between surgeries. Natchiar took her qualifying exams in a wheelchair, two days after a Cesarean-section operation.
Each of the founding team members would gradually be chiseled by a work ethic that had nothing to do with financial incentives. “Dr. V always told us we shouldn’t have high charges,” recalls Viji. “‘Think of every patient who comes in as your aunt or your grandmother from the village,’ he would say. ‘Then automatically compassion will come. Once that feeling comes, then you’ll naturally do a good job.’ [...]
“One of our strengths was that all of us were from the village, so we knew how to talk to the villagers and they used to identify with us,” says Nam. “The workload kept increasing because our reputation was growing.” The team went to extraordinary lengths to make their patients comfortable. It was not uncommon for them to start surgeries in the villages at 1 a.m., “because the weather was so much cooler for the patients then,” says Natchiar
When Viji thinks back to the alchemy and labor of that era, her face lights up. “It was fantastic!” she exclaims. “Now we don’t expect the same amount of work from our staff, but people should know how this place came up.” Then she offers up this gem of insight: “Dr. V always told us to keep charges low and see more patients to make it work. Get less, do more. That was our slogan.” It was an approach that forced them beyond their comfort zone and demanded that they each trade in small, individual dreams for a bigger, shared one.
There is a gradual, catalytic force unleashed when people put aside personal gain in service to a higher vision, day after day, month after month, year after year. That is why money cannot explain Aravind’s success. What the hospital has accomplished today is not by virtue of its bank balance but by, in some sense, its virtue—period.
The Questions You Ask Shape the Answers You Find
A journal entry from the 1980s, written in a series of eclectic questions (and with his trademark absence of question marks), illustrates how intertwined matters of service delivery, leadership, and spirituality are to Dr. V.
It opens with the magnificent obsession he is known for: How to organize and build more hospitals like McDonalds. And then with no warning, it shifts to, How was Buddha able to organize in those days a religion that millions follow. This question dramatically changes the plane of inquiry. Other searching questions swiftly follow: Who were the leaders. How were they shaped. How did the disciples of Christ spread their mission around the world.
And then a final question that he would ask in a thousand different ways:
How do I become a perfect instrument.
Live In the Soul and Be Guided By It
Dr. V firmly believes that action motivated by love exerts a force and organizing power of its own. He makes the cultivation of unconditional compassion for all beings a daily goal—a Dalai Lama-esque endeavor not always easy to pull off. In an early journal entry, he detailed the petty dynamics that can hijack a doctor’s best intentions, before diving into a stream-of-consciousness meditation on the nature of the mind:
You feel drawn to a patient because he’s from your village, known to you, and then you try to do your best for him. But at times, a patient is aggressive and demands some privileges. He says “I know what my trouble is. I do not want to go through all the formalities. Could you see me first?” This upsets you, and with that feeling of annoyance, you treat him. You are not able to disassociate him from his mental or emotional aggressiveness.
Somebody asked Ramana Maharshi [a renowned Indian saint] what he felt when he saw any person. He said, “When I see somebody, I see his soul and I worship it. It may be clouded by ignorance, meanness, selfishness, greed, jealousy, hatred, but I can see the love in him.”
If you could develop that attitude and not react to a person’s defects, and try to help his inner being, you will automatically do your best for him. To do this you must bring into your own being silence, calmness, and quietude. This needs constant practice. It needs enormous practice to realize the experience of silence in you.
You may have it occasionally, and then you hanker for it. It seems to elude you. Your being is accustomed to agitation and it wants it. I can feel it every day, moving in me. I want to live in silence but something else in me wants excitement and runs for it. It feels perhaps the more I get agitated, then the more hard I work. So I shout, give commands to people around me. You aspire for calmness and peace and you want to love all, but to express it is not easy.
Gradually get out of superficial consciousness and go deeper to meet the soul. Live in the soul and be guided by it.
Hold A Vision For Each Person's Highest Potential
Dr. V wants to be able to see with incisive clarity into the heart of people, problems, circumstances, and most of all himself. He is keenly aware of how unguarded patterns of the mind can form into habits and cloud his line of sight, and he understands the constant effort required to transcend those patterns.
In Integral Yoga, an inner poise and self-awareness is the foundation on which you build. As a young surgeon, Dr. V began to use his day-to-day work to sharpen these qualities. To him, this was not an intellectual exercise but one that required operating from the soul—a word that typically comes loaded with religious connotations.
Though the soul is commonly interpreted as the spark of divinity within each being, in Sri Aurobindo’s framework, it can also be defined in nontheistic terms as the inner center that holds each individual’s highest evolutionary calling. It is the seat of what he called “true being,” and it is from here, he maintained, that a power and wisdom arises that sees perfectly in every instance what is, what must be done, and by what means to realize its ultimate purpose. These cues, he says, are typically muffled in layers of ego, conditioning, and negative tendencies. But through persistent aspiration and effort, one can encounter the presence of true being and increasingly dwell in it.
Dr. V found it an elusive but fulfilling residence. Today I had a nice experience of living in the soul, he recorded candidly. Experienced the richness of it and its persuasiveness over all. Not only did he begin to strive for this depth of being in himself, but he also aspired to connect with that part in others as well. Seek the soul of the person, not his money or power, Dr. V urged himself in his early journal entries.
His sister shares a charming story of berating a janitor at Aravind, in Dr. V’s presence, for some minor infraction. Dr. V said nothing at the time, but later he asked her, “Did you shout at his body or at his soul, Natchiar?” Not knowing how to answer, she remained silent. “Shout at his body,” Dr. V told her. “His soul belongs to God. If you shout at his soul, you are shouting at God.”
Holding a vision for each person’s highest potential, whether employee, patient, or partner, shaped Aravind’s model in important ways. It created a density of interconnections that were built not on transaction but on trust. This is what first enabled the organization to see surgical assistants in village women, outreach advocates in indigent patients, and partners in its competition.
Reason Is A Very Poor Tool for Finding Truth
According to Sri Aurobindo, aspiration, the first element in his trifold approach, is vital for approaching the soul. This aspiration is a deep thirst, a commitment to one’s own evolution or self-perfection, and a determination to move in the direction of one’s highest purpose. Dr. V writes of the frequent internal tug-of-war he experiences between pure aspiration and restless ambition. In his journals, he often calls himself out on the distracting impatience of his desire to serve:
Lots of times I get lost in small things like a better order for seeing patients in camps or hospital, better training of doctors, building a better kitchen for patients, etc. There was a sweepers strike. Got mentally worried.
To watch yourself by stepping back is interesting. Normally mind gets frequently bogged with needless problems, confusions. You get Ambitious of having more and more Health jobs, Hospitals etc. To keep the mind absolutely still, to understand the reaction, impulse and attitude and to work from the Soul is the Aim.
This process of skillful rejection is the second element in Sri Aurobindo’s approach, and one that flows into its third, and perhaps most challenging, aspect: surrender. The word here does not mean passive submission but rather an active and dynamic giving of one’s entire being in service of goodness, love, perfection, divinity, or whatever represents the place of “true being” within. Dr. V zeroes in on how strong identification with our minds leads to loss of perspective.
It is difficult to understand surrender. Constantly your mind has got its own fixed ideas or opinions. You get strongly attached to what you think is right and come into conflict with people who differ from you. You are not able to step back and watch your ideas. Lots of times, these ideas are based on the impressions of the mind, and not the higher spiritual consciousness.
Dr. V persistently observed the nature of his mind and came to a startling conclusion. I realize that reason is a very poor tool for finding out Truth, he writes simply. And this is where Dr. V’s spirituality gets particularly interesting.
The mechanics of how Aravind works are covered in some detail by business case studies, but they fall short on the more abstract questions of what created, and continues to animate, the model.
Through a continued process of aspiration, rejection, and surrender, Dr. V was able to tap into an intelligence that went beyond the thinking mind. Seeking a realm of awareness stripped of ego, fears, and preconceptions often provided him with answers, ideas, and convictions that ran counter to the rational and dominant paradigm.
Make a Global Effort in a Small Way
In a small way how can we make a Global effort to conquer cataract blindness.[a journal entry by Dr. V] There is a glimmering oxymoron in Dr. V’s approach. He treated Aravind’s work as a microcosm of the solution: To make a global effort—in a small way. In this quiet, deliberate manner that spanned decades, he lifted Aravind’s relevance from the provincial to the planetary.
Last night I dreamt of expanding the work of Aravind Hospitals to other places, he wrote in an early 1980s journal entry. Get others involved. Include people from other states and countries. His far-sighted aspirations aligned Aravind’s work with a much broader effort, making it one of the strongest links in a global chain of contribution. [...]
Today LAICO, founded by Dr.V and his team, is Aravind’s training and consultancy institute. It aims to replicate the Aravind model to build international capacity for eye care. It has trained more than 6,000 eye care professionals from 69 countries and operates as a kind of United Nations for blindness prevention.
As of 2018, LAICO has helped over 345 hospitals across the world replicate the Aravind model.
It Is Ourselves We Are Healing
Over the decades Aravind has shown the world what is possible when we join the best knowledge and tools of our age with timeless principles, or as Aravind’s founder put it, if “we can combine modern technology and management with spiritual practice.” To Dr. V that combination paved the way for a much deeper goal, one that left nothing and no one out.
“When we grow in spiritual consciousness,” said Dr. V, “we identify with all that is in the world. And there is no exploitation. It is ourselves we are helping. It is ourselves we are healing.”
The excerpts in this article are from Infinite Vision: How Aravind Became the World's Greatest Business Case for Compassion, by Pavithra K. Mehta, Suchitra Shenoy (Berrett Koehler, 2011).