Chennai: At a camp for diabetic retinopathy in the middle class neighbourhood of Adyar in Chennai, Kaliappan, an aged mason from the nearby Malligai Kudiyiruppu low-income group housing colony walks in and presents himself at the registration desk, putting his name down for a free eye check-up.

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One look at the blue-and-white logo of Sankara Nethralaya outside the camp was enough to convince Kaliappan that this was probably the only opportunity he would ever get to have his eyes tested for cataract and treated—at no cost.

Kaliappan’s reflex reaction to the logo is an indication of the trust the eye hospital has built for itself as a charitable service.

Seeing hope: An eye check-up camp at Sankara Nethralaya in Chennai. M. Lakshman/Mint

Two days earlier, the hospital van that stood at Adyar had been to Perumbakkam village, 13km from Kanchipuram, to conduct a general eye camp—going door to door to offer tests for common eye ailments such as cataract and myopia. Its prized offering: tele-ophthalmology, which allows doctors sitting in Chennai to check patients anywhere the van goes and suggest treatment.

“For rural visits, the van is fitted with more sophisticated instruments. A satellite dish provided by the Indian Space Research Organisation (Isro) and a Rs14 lakh glass-grinder to make spectacles on site, donated by Essilor International SA, the French lens and optical equipment company, are essentials," says V. Jebaraj Christopher, the camp planner.

“What started out as a day of rural camp every month in 1997-98 is today a full-fledged department conducting camps everyday," says Dr Sheila John, head of the tele-ophthalmology department, Sankara Nethralaya’s pride and a pet project of the hospital’s founder, Dr S.S. Badrinath. “All because Dr Badrinath persisted on seeing its potential and opened this department in 2002. It helped that Isro gave us a dedicated 256 kbps data connectivity through their satellite and donated receiver dishes for our vans."

With the best equipment and a budget of 15,000 per camp, the project’s initial difficulties were more social than technical or financial.

“Where we had to make a conscious effort was in striking a rapport with the villagers, earning their trust, ensuring we understood local practices and seasons well," says John. “That is the reason why we tie up with an NGO that works with them in other areas as well."

The project’s emphasis on sustained care, instead of one-time treatment, also helps. The team stays in touch with each treated patient for at least three months, ensuring and at times enforcing the use of eye drops so that the operated eye doesn’t get infected and heals in time.

In urban areas, the camp gives poor patients like Kaliappan and retired non-pensioners with children living far away prescriptions for free surgery at the main hospital. Many others who do not qualify for free service opt for paid consultation and surgery.

“The two categories approach the same doctors, wait in the same waiting rooms, use the same restrooms, drink from the same water dispensers, get admitted into identical wards, are served the same food and get operated on using the same kind of instruments by the same qualified professionals," says Dr Sripriya Krishnamoorthy, head of the community ophthalmology department.

Of the 125 daily surgeries performed at the hospital, 45 are free. “About 25 would be complex retinal surgeries, of which 10 would be in the free section," says Dr T.S. Sureendran, one of the hospital’s founding members.

Sureendran remembers the days in 1978 when the hospital worked with just three doctors—including Badrinath, who had just left a lucrative practice at Vijaya Hospital in Chennai to open a service-oriented eye care organization.

Badrinath also remembers their inspiration. “Jagadguru Jayendra Saraswathi Swamigal (religious head of the Kanchi Kamakoti Peetam at Kancheepuram) met a group of young doctors of different specialties and told them about the need to create hospitals in India, which would provide world class care for our citizens at affordable costs," he says. “These hospitals, he suggested, should be run in missionary spirit, with the objective of providing quality care to the haves and have-nots."

Their “hospital" started functioning inside Vijaya Hospital, adds Sureendran. But help was on its way.

Andhra Bank gave them a loan and they bought the land on which the hospital now stands at a nominal price.

In 1998, Sankara Nethralaya became the first Asian hospital to get an ISO 9002 certification.

Today, it has five centres in Chennai and one each in Kolkata, Bangalore, Rameswaram and Tirupati, apart from a number of affiliated clinics and a 50,000 sq.ft facility dedicated to research. It employs 1,400 people, including 82 ophthalmic consultants.

The hospital receives Rs50 lakh in donations every six months or so, primarily from the Gujarati and Marwari business communities in Chennai, as well as trusts in the UK and the US. Its research wing receives about Rs10 crore in grants and donations every year.

“Indian contributors are mainly businessmen who have undergone treatment here and have had a chance to understand the importance of the service as well as its quality," Sureendran says.

He reminisces how Nani Palkhivala, the famous jurist and economist, once said he wanted to be a donor to the hospital. “He used one of our restrooms, and came out saying he hadn’t been to a hospital restroom that was clean until then. That made him judge our quality favourably."

The hospital also receives help from the state and central governments.

“Sankara Nethralaya draws grants for about 55,000 cataract surgeries per year, second only to Aravind Eye Hospital in Madurai, which draws for 70,000. That could be because the former gets many more private donations," says Dr Arun Murugan, who heads project initiatives at the state health society of the National Rural Health Mission in Tamil Nadu.

In his years working with the National Programme for Control of Blindness, Murugan has seen Sankara Nethralaya create widespread public awareness about eye care. Tamil Nadu health secretary V.K. Subburaj agrees: “They see 1,200 patients per day, which is on par with the Regional Institute of Ophthalmology and Government Ophthalmic Hospital, Chennai, the largest eye hospital in Asia."

Sankara Nethralaya has introduced an eye donation scheme which promises free eye care for the family of every donor, a programme suggested by actor Rajnikanth. “That would make people forget their superstitions that work against organ donation and come forward. So what if some not-so-poor people ended up getting free eye care," says Sureendran.

All the doctors, including Badrinath, work on a fixed monthly salary instead of charging consultation and surgery fees for every patient.

“This means that doctors don’t push for unnecessary tests and procedures in order to draw more fees," says Dr Sripriya. “The doctors get complete intellectual satisfaction given the kind of complex work they do."

There is a flip side to the hospital’s success. Rakhal Gaitonde, an independent public health professional, says the state government shouldn’t become too dependent on a private service provider.

“It’s really a systemic issue, outside the realm of what the hospital can address," he says. “There are still people who are so remote that they can’t access Sankara Nethralaya and their idea of healthcare can only be the government hospital."