Tanuja Joshi, MD, Venu Eye Hospital, New Delhi, speaks to Mayank Chhaya on the fight against blindness in India that has a fifth of the world’s blind | SAM Conversation
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00:00On October 8th the World Health Organization validated India as having
00:16eliminated trachoma as a leading cause of blindness in the country and around
00:22the world. While the validation was a long time coming and highlighted the
00:27convergent success of many endeavors around India, it also ironically served
00:32the purpose of reminding that the country still remains what has often
00:37been described as the blind capital of the world. One institution that has been
00:43at the forefront of repairing vision impairment and restoring sight to tens
00:47of millions of Indians for over four decades now is Venu Eye Hospital based
00:53in New Delhi. Founded in 1980 by a remarkably passionate and professionally
00:59successful ophthalmologist the late Dr. Rajendra Seth, Venu has treated or 8.5
01:06million people, a vast majority of them free of charge in line with its
01:10founding philosophy. It now runs five eye hospitals. By the time Dr. Seth passed
01:17away in 1996 at age 56, Venu's mission had firmly been institutionalized. Nearly
01:25three decades later, furthering that mission is his successor and managing
01:30director of the Venu Eye Hospital, Tanuja Joshi. As India addresses its
01:36widespread problem of blindness, most of which is caused by the poor with
01:41cataract unable to access treatment, Tanuja says Venu keeps its focus on
01:46expanding access to the economically weaker Indians. She spoke to MCR from
01:51New Delhi. Welcome to MindShare Reports Tanuja, it's a great pleasure to have you.
01:56Thank you, thank you for inviting me. I want to start with something rather
02:02positive. I read that the World Health Organization has just validated that
02:08India no longer has trachoma as a major cause of blindness. Tell me a bit about it and
02:15whether Venu being an eye institute, what kind of role or perspective you have on that?
02:23So, I mean, India had been saying that we don't have trachoma, but some years ago,
02:30there was some sporadic cases that were reported. In fact, Venu was part of the
02:362005-06 rapid assessment that the government did on trachoma. But we're very
02:43happy to say, I mean, that finally WHO has accepted, because there was a lot of,
02:49you know, campaigning done by the Indian authorities to say that, you know, we
02:55really don't have trachoma anymore. And there had been some very, very sporadic
03:00case. But we're glad that now finally WHO has accepted that India doesn't have
03:05it's eliminated. So it's actually a very interesting day today, because it was only
03:11today that it came in the news.
03:12Indeed, indeed. You know, trachoma is an interesting problem in the sense that it has
03:20things like poverty, hygiene and other things feeding into it. Especially in the
03:26Indian context. I mean, India has been a sitting duck for any number of reasons for
03:31that. So it is especially remarkable that we no longer have it.
03:36Absolutely. Absolutely. Because poverty is still there. Those issues, health issues are
03:40still there. But I think something like polio, you know, we have had a success story.
03:46And it's interesting to see that this also has been successful as a campaign.
03:51Yeah, I think people know. Yeah, sorry, go ahead.
03:55No, in fact, India, when it was the first country to launch one of the blindness
04:00schemes in 1976, the National Program for Control of Blindness and the initial effort
04:06of that scheme was for trachoma control.
04:10And so that part, you know, we've done very well.
04:14Right. You know, people don't realize that it's a bacterial problem.
04:18It starts with that something that could be pretty quickly prevented or avoided
04:23altogether. And then it goes up and finally it's irreversible.
04:27Right. Absolutely. And it's also it spreads.
04:30It spreads with touch. It spreads with hygiene issues.
04:33And so definitely we are very happy that at least that part we have been able to manage.
04:39Right. To broaden our conversation a bit, India is home to 17 percent of the global
04:47population and accounts for 25 percent of the world's blind population.
04:53That's an astonishing statistic in itself.
04:56How do you as a major institute and hospital look at something like that?
05:03See, the problem is definitely lack of access, definitely awareness
05:09plays a part. But most of the health care facilities in India are in the urban areas.
05:15Now, of course, it's also going into the smaller towns.
05:19But most of the disparity of the population, majority being in the rural areas and the
05:26services being in the urban areas is one of the issues.
05:31And also a majority of the blindness is due to cataract, which is age related.
05:39And so the elderly and the children are the vulnerable segment.
05:44And in the rural areas, the elderly are not anyway given importance.
05:50So the problem is that so what the government, you know, the three tier network that the
05:57government has with the referral centers or the teaching hospitals, with the district
06:03hospitals, the secondary level and the primary health centers, it's a beautiful scheme.
06:08It's a beautiful program.
06:12But unfortunately, in the government set up in the rural areas, you know, there are lack
06:17of resources, whether it's doctors, whether it's the medicine.
06:23So Benu has adopted a similar approach that we have our main teaching and referral
06:28hospital in Delhi. And at the second level, we have our 30 bed rural hospitals, which
06:34we call our satellite hospitals.
06:36And what we call the PHCs, we have our vision centers and camps.
06:41Right. We have adopted a similar model.
06:44In fact, most of the eye care organization in India follow that.
06:47And now, see, when Dr.
06:49Seth started this in 1980, it wasn't such a structured thing.
06:54In those days, it was either the government hospital, the trust hospitals and all the
07:00trust hospitals across India have actually implemented a similar model.
07:05Today, it is known and it is being taught as a subject of community of thermology, which
07:10is, you know, the outreach model has become actually a model.
07:15But earlier, it was the response that philanthropists responded to the situation and it
07:21evolved as a three tier network.
07:23Right. And that's the only way that we can reach the population in the
07:29rural areas. Yesterday, we did a camp, which was in Sonipat, and we had an OPD of
07:35about 100 patients who came and we had 33 patients who were advised cataract.
07:42You know, interesting, you should mention cataract because I was, again, reading a
07:47statistic on that 66 percent and a little more, the blindness results because of
07:53cataract. Once again, it comes down to the fact of poverty.
07:59People with no money cannot handle cataract.
08:02It's a relatively simple operation.
08:04And as a major eye institute, I'm sure you deal with it all the time.
08:08Is there a national policy on something like cataract, for instance?
08:12There is. There is.
08:13The government has a policy, but I think the government statistics say something like
08:1962 lakh cases were operated last year.
08:22In average, we average about 60-65 lakh cases every year.
08:27That's hardly anything.
08:29Right. It's hardly anything when you look at the aged population in India.
08:33And the other sad part is that the other cause of blindness is just refractive errors.
08:40All we need is a pair of glasses.
08:44So it's about 19 point something, almost 20 percent.
08:47So 80 percent of blindness in India is avoidable.
08:50And think about the economic impact.
08:52I mean, so many people blind have a direct bearing on the country's economy.
08:58And yet, like you said, the figures are nowhere near where they should be in terms of
09:03attending to this problem.
09:05Because the government, in fact, the WHO and International Agency for Prevention of
09:09Blindness had also started something called Vision 2020, a consortium that was
09:15supposed to focus. 2020 come and gone, but we're still struggling with achieving the
09:19targets. And women, of course, and children are more vulnerable.
09:24So that's, you know, it's something that we deal with all the time.
09:30Men still do have access, but women and children are still deprived.
09:36Is this a cultural issue in the sense that we don't seem to be taking blindness that
09:42seriously? I mean, it's a condition that 80 percent of blindness could be avoided.
09:48Yes. And yet we have it.
09:50That means we seem to be rather lackadaisical about this.
09:54See, 60 percent, which is cataract, unfortunately, you know, with age, people feel that
10:01they won't see, they can't hear, they just accept things.
10:04Exactly. And I remember when Dr.
10:08Seth started the work in 80, he would go and tell patients, Kinne, I can give you sight
10:15back. And the patients were not reaching him.
10:18And then he realized, did I do a service or a disservice?
10:20He was happily satisfied that with age he can't see and I've gone and disturbed him.
10:25So that's when he realized that, no, you know, I have to bring them myself because
10:29there's nobody to bring them.
10:30In the 80s, the patient had to come and stay in the hospital for five, six days.
10:35Right. So there was nobody who would bring them.
10:37A person who would bring was an earning member.
10:39Women wouldn't accompany as an attendant.
10:42And of course, over the years now, things have changed.
10:45So that's why in the past we would and we still do.
10:49We bring the patients in the buses, otherwise they will not reach us.
10:52Right. If we do a camp in the rural area and we tell the patient, this is the address.
10:56Can you reach us? They don't come.
10:58Right. I would like you to talk about Venu.
11:03You've been with Venu almost since its inception and especially in the context of the
11:10extraordinary work done by Dr.
11:12Seth. Take me back to your history and tell me about its growth, because I've seen in the
11:18early days when I used to be in Delhi, but now you have several centers around the
11:23country and you are a major presence.
11:25So tell me about that.
11:27So the genesis of the organization, of course, was the founder, who was a private
11:32practitioner doing very well.
11:34But at the age of 36, he had two massive heart attacks.
11:38And that was in 1976.
11:42And in the mid 70s, his private practice used to yield at least 10 lakhs a year.
11:47He was very successful.
11:49And that's when he decided that I have to give back to society.
11:52And so he would go to the rural areas, like I mentioned, tell the patient, come to my
11:58clinic. And he realized they were not reaching.
12:00So then he got a van and he started bringing in the van, operating and taking them back.
12:05And that's how the camp started.
12:07But then in some campsites, patients would say, you didn't take us last time.
12:11There was no space. Now you're again not taking.
12:13So wherever the need he felt was more, a clinic was established.
12:18And then from there, whenever the numbers increased further, then we converted them
12:23into a hospital.
12:25And that's how this three tier network started.
12:28And then when you have this kind of a network, you also need human resource.
12:32You need doctors. You need the technicians to be there.
12:35How do you bring them?
12:36Because not everyone is willing to go.
12:38So then we evolved as a teaching hospital.
12:41And when you're a teaching hospital, you do have the capacity to man all these hospitals.
12:48So for us, it was just a natural evolution in response to what the patient's need was.
12:54And that's how we have grown.
12:57And we've seen about 86 lakh patients to date.
13:01And we're very happy to say that over 55, 60 percent of them are free of cost.
13:06I see that's a big number.
13:08Because the mission of Dr. Seth was to reach the poor people.
13:12And so we still have, you know, the focus is still to reach out to the poor patients.
13:20Tell me about the combination that you've developed as a teaching hospital, as well as
13:26something that does such vast charity.
13:29How do you manage funding?
13:32Because it takes a lot of money to do what you do.
13:35I'm curious to know how you managed to raise funding for this.
13:39So in the in the earlier part, it used to be almost 80 percent free patients.
13:45And we used to get almost 80, 85 percent donations and grants.
13:50And a lot of grants we were getting from overseas, from Germany, from UK, from USA.
13:56Those were the countries because they were international funding agencies which are
14:01funding us. But somewhere in the 2000s, when the recession hit the West, we realized
14:07that the funding is dropping.
14:10And because the funding dropped, they also internationally had to take a decision.
14:14And they said, India is now a success story in eye care.
14:19And actually, in many ways, India is.
14:21So then with the limited funding that they had, their focus shifted to both Africa and
14:26Bangladesh. So they told us that, you know, now you have to start looking
14:31to do something yourself.
14:33So that's when we as an organization also realized that from doing 80, 85 percent only
14:38free work, we also now have to start doing some paid work.
14:42Right. And because we are Delhi based and there are patients who can pay.
14:47So then we started focusing a little more on our own revenue generation.
14:51We started optical services.
14:53So we sell spectacles.
14:54We started a pharmacy.
14:56And then we also opened up to some of the teaching programs where, you know, the
15:00students would pay.
15:03So there are two parts of the teaching program.
15:05One is a postgraduate teaching.
15:07There, of course, the students don't pay because that's an investment we make.
15:11But there are also practitioners who want to hone their skills.
15:15They're private students.
15:17So we then charge them not a huge amount.
15:20So education, of course, doesn't get us a huge amount, but it does have some cross
15:25subsidy. Then, of course, we also go to the Indian donors.
15:30Right. Which is not always very easy to get money at the top.
15:35So we have been looking at our own revenue.
15:37So now we are able to do 50 percent charity and 50 percent paid.
15:42So then we are cross subsidizing from the paying patients that we have.
15:47Oh, I see. We still have challenges because while we are able to meet our operational
15:51cost, we still have challenges when it comes to, you know, the technology being
15:56upgraded, like equipments to be bought or now that we have this campus in South
16:01Delhi, maintenance of buildings.
16:04So these still continue to be a bit of a challenge for us.
16:07But your underlying philosophy still remains charity, right?
16:10Absolutely. Absolutely.
16:12Even though the government mandate to us is that we do 25 percent of our outpatient
16:17free and 10 percent of our inpatients free because the land that we have has been
16:22given by government at a subsidized rate.
16:24But even the government has written officially that when it was doing far more than
16:30what it is supposed to be doing, as a philosophy, we want to keep it as 50-50.
16:36Because I remember Dr.
16:38Seth initially did engage with him quite a bit.
16:42His entire fuel was compassion and charity.
16:47I remember it very vividly.
16:49Absolutely. So we were doing 80 percent free work.
16:53Today, we had to, of course, bring it down.
16:55And in fact, Dr.
16:56Seth used to always say that, you know, there may be a situation, increase your
17:01volumes. You know, so if you're doing 100 patients, operating 100 patients and 80
17:06patients you are doing free, take it to a thousand and make it 500.
17:11So you move from 80 to 500, you know, so there will come a situation that you may have
17:16to break even because, say, if you only depend on donations and grants, there is a
17:22limit to growth then.
17:24Yeah. You know, given your decades long expertise and success in the space, I was just
17:31wondering if you are in a position to go global because there are so many countries, for
17:37instance, in Africa and elsewhere, they would need something like this.
17:43I'm saying if you were to consider the same model in Africa, wouldn't you expand your
17:50footprints? In fact, we have done some work in the past, but that was when we have
17:58support from international agencies because that requires a huge amount of funds and
18:05funding. So we have done some kind of, you know, with Bangladesh, with Myanmar, with
18:11Nepal. We've done a lot of work in terms of training their doctors, in terms of going
18:16there, sending our teams for surgery.
18:19But unless we have some kind of funding for it, that's just a bit of a limitation.
18:26We have the expertise, we have the experience and we used to do it.
18:30But that was pre-Covid, post-Covid we have not yet started it.
18:34I see. Tell me as the managing director of the whole institution now, what kind of
18:41challenges do you face on a daily basis?
18:45I'm sure by now you're a well-oiled machine after these many decades, but I'm sure at the
18:50same time you have several challenges that you confront.
18:54I think human resource, doctors and the technical team, because in the last 15, 20
19:02years, a lot of private players have come, a lot of business houses have come into
19:07healthcare, unfortunately, or, you know, it also is a challenge for us.
19:13So what's happening is there's a lot of eye hospitals that have opened up and then they
19:19have these chains of hospitals.
19:21So every hospital needs a doctor, every hospital needs the optometrist and the
19:26paramedical staff.
19:28But the colleges, whether it's medical colleges or paramedical colleges, have not
19:33increased that much.
19:35So the number of students that are coming out are being absorbed by these people
19:40because they pay them phenomenally.
19:43Which we find a challenge to always, of course, improve much, much better.
19:47We are, but that is still a challenge for us.
19:50So that becomes a bit of a problem these days, getting doctors and retaining them.
19:56Because another thing, I mean, in India, you know, gone are the days, at least in our
20:02generation, where we looked at stability.
20:04These days, everyone is jumping.
20:07Absolutely.
20:08And nobody wants to go to the rural areas.
20:10That's another problem.
20:11Right.
20:13You know, another challenge for you is that globally, the problem of blindness is in
20:19pockets. Say India, you know, India still has, Bangladesh, you mentioned Myanmar,
20:24Nepal, parts of Africa.
20:26But beyond that, the kind of chronic problem that you see in these areas, you don't
20:31see elsewhere. And that perhaps limits your ability to raise funds, I suppose.
20:37True. And then, you know, while Cataract does get funding and even to some extent
20:44refractive errors, but that people are willing to pay for spectacles, the challenges
20:48that now we are having is with the longevity of life.
20:53The problem is the diabetic problems, you know, diabetic retinopathy is a huge
21:00problem. Also, the macular degeneration in the US, of course, that is one of the big
21:05problems that they have.
21:06But even in India, longevity of life and also the number of, you know, children who
21:13are now the premature children, their survival is much better.
21:19So, you know, these are challenges which are definitely there and they're expensive.
21:24They're not like Cataract. Cataract is, in that sense, a far more economical problem to
21:29solve because you also get funding for it.
21:32But these are the challenges which are and also the prognosis is very difficult to
21:39tackle. And so age related issues are also now coming up and India is a diabetes
21:49capital. And the unknown diabetics are far more.
21:54We did a project some years ago where we took two rural areas and one urban and one
22:00semi-urban area to screen for diabetes.
22:04And it's not that the rural areas didn't have diabetes, they were unknown diabetics.
22:07Right. Which is even worse.
22:10And people do not necessarily make the connection between diabetes and blindness.
22:16Even now, people, I mean, it just doesn't strike them.
22:19The two are quite connected.
22:21Absolutely. And one of the first organs that diabetes will affect is eyes.
22:26Exactly.
22:28In fact, what we are now working on is that because our vision statement is good sight
22:35and quality life for all.
22:37Good sight not necessarily gives you quality life because there are other issues that you
22:42have. Today, if we've treated you for cataract and you have diabetes, tomorrow your
22:49eyesight will get affected and quality life will get affected.
22:53So we have now started also a campaign to control diabetes and that also in an
23:00integrated way.
23:01It's like you continue with your medication, but naturopathy also helps.
23:06So we are bringing in naturopathy to help because at the end of the day, we want so
23:10because Venu has responded to the need of the patient always.
23:13So we find there is this need where if a person comes with diabetes, he has to be helped
23:19to manage it, because only then can our ophthalmologist do justice to the patient.
23:24Right. If you're treating a diabetic retinopathy patient and he doesn't control his
23:29diabetes, the ophthalmologist can do just that much.
23:34You've been around for like as an institution, you've been more than four decades
23:39now. How would you describe the way your interactions with successive governments have
23:46changed in terms of responsiveness to what you do?
23:52I think we have so far a decent relationship because one is that we've always been
23:59apolitical and secular.
24:01So and I think the legacy that we have inherited, that 44 year legacy, whichever
24:08government comes, they respect whatever we do.
24:12And the reason is because, you know, we just work and we don't get into any of these
24:18things. So we have always had a good relation with any government that has come,
24:23fortunately. You know, Dr. Seth was like that and you've kept up that legacy.
24:28I mean, I know that for a fact.
24:31Tried to, because I think I was just so raw when I came to him that he just molded me.
24:37I remember it so well.
24:39It's all very vivid in front of me.
24:40Yes, yes. On that note, Tanuja, I want to thank you very much for your time.
24:45I'm glad we did this.
24:48This is an important...
24:49I wanted the people here to know the work that you're doing.
24:52So I hope to some extent it makes a difference.
24:56Thank you so much.
24:58Thank you so much for giving me an opportunity.
25:00Oh, not at all. All eminently deserved.
25:01All kinds of random people get time these days.
25:05So why not someone of substance?
25:08I always try to do that on my little show.
25:11Thank you so much. Thank you.