Kumari lives in Arni, a large town in Tiruvannamalai district in north Tamil Nadu. She has been the the only earning member of her family since her husband abandoned her family, working as a coolie for daily wages. Then, her cataract set in, preventing her from going out to work or taking care of her home. Cataract is a clouding of the natural lens of the eye and is the leading cause of blindness in India and around the world. Cataract normally affects people older than 60, but for some like Kumari, who is about 50 years old, it sets in earlier. Kumari would have been one of 12 million blind people in India if it not for the Sankara Eye Foundation in Coimbatore.

The Foundation’s doctors performed a free cataract-removal surgery on Kumari. While recovering in the general ward of the Foundation’s hospital, Kumari said that she wanted the Sankara doctors to help her son Velu who had lost his sight in one eye during a farming accident when a cow’s horn gored his eye.

The Sankara Eye Foundation began in 1977 as a small low-cost clinic in Coimbatore, set up by two young general practitioners Dr RV Ramani and his wife Dr Radha Ramani. Over 40 years, the Foundation has conducted about 1.5 million eye surgeries free-of-cost, mostly for the rural poor. RV Ramani, who is now the founder and managing trustee of the Foundation, traced this journey.

“We both had successful private practices and a stable of well-to-do patients, but we both wanted to do more to help those who could not afford proficient medical care,” he said about how the couple decided to start the clinic. “Indian healthcare swung to two ends of the pendulum – the first being expensive private healthcare and the second free government services [which lack in quality].”

In the late 1970s, the Tamil Nadu government had already set up general health clinics in every district and so the Ramanis decided to pick a specialised branch of medicine. Ophthalmology seemed ideal since successful treatment has immediate results and good vision is invaluable to the lives of people living in India’s rural areas.

“In the beginning I convinced a team of [private] doctors to contribute a few hours every week to the clinic – no more – and collected 50 paise from every visitor, which we would only use for medicines and for our cleaning lady,” said Ramani. “You see in order for social enterprise to be successful, it has to be conducted on a sustainable model.”

Fast-growing enterprise

The Ramanis started their clinic in a small facility provided by the Sri Kanchi Kamakoti Trust, a religious charitable organisation, in May 1977. Given the early success of the clinic, Ramani registered Sankara Eye Foundation as a public charitable trust in 1981.

The original Sankara eye clinic in Coimbatore, run out of property donated by the Sri Kanchi Kamakoti Trust. (Photo: Sankara Eye Foundation)

By the mid-80s, Ramani saw his small social enterprise receive tremendous encouragement from donors and the medical community.

This enabled the Ramanis and their team to switch to a rather unique model of providing free surgeries to a majority of patients. The Foundation began completely free eye care for 80% of its patients who came from poor families and charged the remaining 20% who could afford to pay for treatment, thereby cross-subsidising the free eye surgeries.

Following this model, Sankara Eye Foundation has established itself as one of the largest eye care providers in India and the world. Their largest programme of rural outreach for those with cataract called “Gift of Vision” works on a hub and spoke model in every state. This means that Foundation starts work in a big town by conducting camps to screen residents for eye and vision-related impairments and treating those who need it. Once it has established its reputation with people in towns, the doctors start conducted camps in smaller villages around the town.

RV Ramani (left) at a "Gift of Vision" rural eye care camp run by Sankara Eye Foundation.

“We rely on the assistance of local panchayats, zilla parishads, Rotary and Lions’ clubs and respected members from each community to bring patients to the camp,” said Radha Ramani. “Every camp is well publicised and is usually at the most prominent building in the town like a wedding hall or a school – so they are literally hard to miss.”

The camps are overseen by medical professionals and counsellors and those identified as requiring help are put through further tests. If they require and are fit for surgery, the Foundation takes them to the nearest hospital and where its doctors perform the necessary medical procedures. Once treatment is over, patients are sent back home and instructed to visit subsequent camps for follow-ups.

A Sankara health worker conducts a basic eye test, which is the first step in the screening process to identify those who might need surgery, at a camp in rural Tamil Nadu. (Photo: Sankara Eye Foundation)

“Stringent procedures are in place and copious notes are taken by our very well-trained team,” Radha Ramani emphasise. “Free, readily available and state-of-the-art eye care provided at the doorsteps of rural India is the mantra of Sankara.”

There are other large ophthalmological hospitals in South India like Sankara Netralaya, a charitable hospital that performs 40% of its surgeries free of cost, and Aravind Eye Care, which also follows a cross-subsidisation model to offer free service to patients who cannot afford to pay.

Blind spot

According to the National Programme for the Control of Blindness Of the 12 million people suffering from blindness in India, 60% or about 7.2 million have visual impairments that are treatable – like cataract and glaucoma among the aged and treatable refractive errors among children. Sankara Eye Foundation has been treating a large number of these people. In 40 years, the Foundation has conducted more 23,020 rural outreach eye camps, screened 4.5 million patients and performed 1.5 million free eye surgeries. The Coimbatore headquarters of the group, which is now set in a sprawling five-acre campus, also has one of the first eye banks in India that retrieves and stores eyes from donors cornea transplants.

A girl writes on a blackboard at a follow-up eye camp held at her school as part of Sankara Eye Foundation'sjuvenile blindness prevention programme. (Photo: Sankara Eye Foundation)

The Sankara doctors observe that in rural populations, women’s eye care is more often neglected than men’s. Sixty percent of the Foundation’s patients are women. Rani, who works as a farm hand in Arni, is one of them. Her husband had had a cataract surgeries at the Sankara headquarters in Coimbatore and recovered his eyesight quickly. This encourages Rani to seek treatment and, even though she had not left her village in more than a decade, she travelled 400 km to Coimbatore alone for the surgery.

“What motivates all of us here in the headquarters is that our larger vision is clear – no pun - we help blind men, women and children see,” said the Foundation’s head of operations Bharat Balasubramaniam. “The fact that Dr Ramani and Dr Radha remain so active in the organization while not having been paid a single rupee since they started this forty years ago is also something that deeply motivates us.”

The group has also expanded their services to other states including Guntur in Andhra Pradesh, Bangalore and Shimoga in Karnataka, Anand in Gujarat, Ludhiana in Punjab and Kanpur in Uttar Pradesh. It plans to start operations in Rajasthan, Madhya Pradesh and Maharashtra soon.

“Yes, of course we face practical challenges every day.” says Balasubramaniam. “It takes great effort and time to procure permits for our new projects and to identify and train our staff. The concept of quality, high-volume surgery, hygiene and gender parity have to be taught and imbibed by all.”

Patients waiting to go home after the completion of their successful cataract surgeries. (Photo: Sankara Eye Foundation)

Corrections and clarifications: This story has been edited to remove an error that misstated the location of the hospital and to correct the name of the founder doctor.