Jet-lagged, following 24 hours of travel from Boston, sweat rolled down my forehead only to return moments after I had wiped it away. Even the English signs seemed suddenly indecipherable in the humid midday heat of Pondicherry, India. I’ll never forget struggling to find the office of Dr Venkatesh, the Chief Medical Officer at Aravind Eye Hospital.
A staff member gently tapped me on the shoulder, seeing my visible confusion, before guiding me toward the office comfortably nestled in the corner. I felt palpably nervous walking in, but Dr Venkatesh greeted me with a warm smile and genuine curiosity, asking about my background before casually mentioning his plans to construct Aravind’s first pickleball court. It was a small, human moment that immediately put me at ease, yet it also offered a glimpse into a culture where community, sustainability and vision existed in harmony.
At Aravind, I quickly came to realise that nothing – no room, department or process – was left untouched by intention. The hospital campus was a sustainable model: scrap materials were repurposed for building projects like our new pickleball court; food was grown on-site to serve staff and patients alike; and the campus’s potable water systems maximised safety while minimising waste. Surgical instruments were carefully sterilised for reuse between patients – the only feasible way a single surgeon could safely operate on up to 100 cataract cases daily. Many staff lived in residential buildings scattered across the campus, creating a self-sustaining ecosystem that kept the hospital running with an almost monastic commitment to purpose.
Though the scale of Aravind’s clinical operations is well documented, living it firsthand as an aspiring ophthalmologist was another experience entirely. What struck me early on was the breadth of skills held by Aravind’s mid-level ophthalmic personnel. They were not just assisting; they were the steady hum of the engine powering the hospital. Some were expertly trained to perform refractions or check intraocular pressure using non-contact tonometry, while others knew how to repair slit lamps and troubleshoot imaging and diagnostic devices on the spot. Their presence gave each subspecialty clinic a rhythm, allowing ophthalmologists to focus on complex decision-making while everything else moved seamlessly around them.
My primary role at Aravind was to evaluate the effectiveness of an AI-assisted fundus camera device for glaucoma screening. While the device and its integration were fascinating, I quickly found myself more captivated by the environment around me – the systems, the values and the people.
One of my most potent experiences came early on during a rural outreach camp. I joined a team that drove several hours to a primary school, where we unloaded equipment from a bus and set up stations for screening hundreds of patients for ophthalmic conditions. Seemingly within minutes, the Aravind staff had transformed the decorated classrooms into a functioning eye clinic, replete with multiple stations for each task. I tried to help set up the refraction station while doing my best not to get in the way – a common theme when it came to my well-intentioned interventions. Despite my fumbling efforts, the team treated me with patience and good humour.
These outreach camps were envisioned initially by Govindappa Venkataswamy (known lovingly as Dr V), the founder of the Aravind Eye Care System. His philosophy was radical yet straightforward: if patients can’t reach care due to distance, poverty or disability, then that care must come to them. That ethos still reverberates through every outreach effort, every smile from a technician guiding an elderly patient through an exam, and every conversation about how best to increase access for the underserved. Equity isn’t just an aspiration at Aravind; it is engineered into the system. Patients who can pay are charged, and their fees subsidise those who cannot. From the waiting rooms to the operating theatres, there is no distinction in care delivery.
My time at Aravind reshaped how I think about healthcare systems, especially in high-income countries like the US. We often equate high-quality care with high costs or assume that innovation requires adopting the latest cutting-edge technologies. But Aravind taught me that true innovation lies in rethinking workflows, empowering allied health staff, minimising waste and designing for access, not just excellence.
As I continue my training, I know the technical skills I learn will be important. But just as important will be the lessons from places like Aravind: that purpose and efficiency can coexist; that equity is a design choice; and that humility is a form of strength. I arrived at Aravind to study a piece of AI hardware, but I left with a renewed sense of what it means to serve. I hope more medical students and trainees have the privilege to learn from systems like Aravind. The exposure not only broadens clinical understanding – it expands one’s moral imagination.
On my final day at Aravind, as I sat in the guesthouse waiting for transport, I had the unexpected honour of sharing breakfast with Ravilla Ravindran, the Chairman of the Aravind Eye Care System and a pivotal figure in its exponential growth. I knew his biography well: a cataract surgeon turned visionary leader, with decades of experience building and replicating Aravind hospitals across India. I expected a polite farewell or perhaps a few questions about my time at the hospital. Instead, the conversation took a different turn.
As we sat across from each other over plates of idli and sambar, Dr Ravindran posed a question I didn’t expect: “What do you think are the principles a person should live by? Not just as a doctor, but as a human being?” The question landed with quiet weight, and I still think of it often. We spoke about honesty, humility and openness. We discussed the importance of keeping a moral compass and a spirit of service alive, and about the need to constantly seek better ways to serve, regardless of where the idea originates or who brings it forward. It wasn’t a grand speech or a formal lecture. It was a reflective moment between two people committed to the same pursuit in different ways and at varying stages. Like so many things at Aravind, it reminded me that intention, when paired with humility and action, is what makes good care possible and what makes meaningful lives possible, too.
Declaration of competing interests: None declared.
