2008 Gates Award for Global Health

May 29, 2008
Prepared remarks by William H. Gates Sr., co-chair

It's a delight to be here this evening to present the Gates Award for Global Health.

I want to thank Nils Daulaire and the directors and staff of the Global Health Council for their life-saving work. One might be tempted to think that it was a happy coincidence for the council when the world began to turn its attention to global health. But that was no coincidence—the council helped make that happen!

Thank you for your passionate advocacy for the cause of global health.

When Bill and Melinda came to the Global Health Council to launch the Global Health Awards, they were inspired by two opportunities: first, the opportunity to support creative organizations that bring health care to those who don't have it. And second, the opportunity to highlight the original thinking that makes these miracles possible.

Increasingly, we're finding that the most amazing breakthroughs are delivered by groups that have found out how to combine self-interest with concern for others into one system that serves people who used to be left out. This is creative capitalism—an approach where governments, businesses, and nonprofits work together to stretch the reach of market forces so that more people can make a profit, or at least make a living, doing work that saves and improves lives. The organization we're honoring tonight has developed a system of eye surgery that is so efficient that the cost of the services is covered by the people who receive the services—even though most of the patients are poor, and 70 percent of them are treated for free. 

In 1976, the founder of Aravind, affectionately known as Dr. V, retired at the age of 58 from a long career of service as an ophthalmologist for the Indian government. Working first for the army, and then for public hospitals, Dr. V had made his mark as a renowned eye surgeon, clinician, researcher, and developer of community programs.

Ordinarily, retirement marks the end of one's career, and given all his accomplishments, retirement would have been justified. But Dr. V was just getting started.

His first step was to ask his sister and his brother-in-law, Dr. Nam, who is here tonight and currently chair of Aravind, to join him in setting up a new non-profit eye hospital. In India, leaving government service for the private sector usually means tripling one’s income. For Dr. V, it meant mortgaging his house to provide Aravind’s start-up money. For Dr. Nam and his wife, it meant working twice as hard for half the salary. But the three of them were on a mission.

During their government service, these pioneers had seen the devastating effects of blindness. Being blind in any rural village in the developing world leaves a person in darkness and dependence. They cannot earn income, they cannot assist in the duties of the household, they become a financial burden to their families, who are often already poor. 

And the problem was especially acute in India, a country with nearly seven million blind people—almost twenty percent of all the blind people in the world.

But Dr. V and Dr. Nam knew that up to 80 percent of blindness was due to cataracts, which could be cured with a routine surgery. From their point of view, "if we know how to fix it, then no one should suffer from it." That's why they started to call it "needless blindness." It doesn't have to happen, and they set out to make sure that it wouldn't.

But there was an obstacle. Cataract surgery can easily cost more than $3,000 in the West. Millions of people they needed to reach couldn't pay even one percent of that. How could they possibly take care of them?

They started by opening an 11-bed facility with four staffers. They called the hospital Aravind, after a famed Indian philosopher who believed that humans beings—by exercising their sacred duty to help others—could harness a spiritual force in their work that would allow them to accomplish miraculous things. 

Thirty years later, Aravind is the largest and most productive eye care system in the world. Last year, they treated approximately 2.4 million patients, and their doctors performed more than 280,000 sight-restoring cataract surgeries. Thanks largely to Aravind's efforts, the estimated number of blind people in India fell an astonishing 25 percent between 1990 and 2002. In a country with more than a billion people, 11 percent of all Indian ophthalmologists have received training through Aravind.

All this came from a humble little hospital with 11 beds, four staffers, and one brilliant ophthalmologist who mortgaged his house to start a hospital inspired by his love of humanity and his devotion to service.

I would now like to tell you about the philanthropists whose generosity has made this possible. But there is little story to tell. Aravind's budget is almost 90 percent self-generated.

How did they do it?

Dr. V was a brilliant combination of the spiritual and practical. When he wanted to develop a system to achieve the maximum productivity for the money, he went to Oak Brook, Illinois, and visited McDonald's "Hamburger University," because he, too, wanted to serve billions worldwide.

Dr. V recruited the best eye surgeons he could find, starting with Dr. Nam—and always attracted those who were willing to work long hours for low pay out of love for humanity.

They hired young women in rural villages, whom they trained as assistants. This cut down on the number of doctors they needed.

And they made the surgery available to millions of people with an Aravind innovation. In cataract surgery, surgeons remove the clouded natural eye lens obstructing the patient's vision and replace it with a clear artificial lens. This lens costs anywhere from $75 to $100. So they pioneered a technique where they could make a lens of comparable quality for two dollars. When you want to multiply the number of people you can reach, just cut a key cost of the procedure by 98 percent!

Even though Aravind serves so many patients at such a low cost, their patient outcomes are ranked among the best in the world. Every patient receives the exact same world-class medical care, but only 30 percent of them pay. The other 70 percent get free care that is subsidized by the paying patients.

The only difference in service between the paying and non-paying patients is the amenities they receive. If you can't pay anything, you get very simple, but very clean accommodations. If you want a private room with air conditioning, you pay for it, and the fee will help fund surgery for others.

Aravind also serves the millions who can't easily reach their hospitals by running more than 1,000 free eye camps each year, where villagers can have digital pictures of their eyes taken and emailed over long-distance WiFi networks for evaluation by Aravind doctors.

Aravind's super-efficient approach has brought it an average annual return on equity of more than 75 percent, and allowed them to pursue debt-free expansion of their hospitals. They're not only making a profit, their profits are financing their expansion. 

This is a brilliant example of creative capitalism. They have driven down the cost of a life-changing medical procedure to the point where it is widely available to millions of poor people—and the services are funded not by foundations and not by governments, but by the people who receive them. It can keep on going and getting larger forever.

The people at Aravind understand their obligation to spread these remarkable methods, so they share their discoveries and approaches with others. They have trained 231 hospitals in India and around the world in everything from financial management, to procurement, to showing how to train personnel to assist in surgery. Muhammad Yunus has asked them to work with 7 hospitals of his in Bangladesh. And they're sharing the wealth that came from the discovery of the low-cost lenses. Today, their lab exports 700,000 of them every year to more than 120 countries.

Of course, all this talk about Aravind's numbers might take the focus away from the impact they make on the lives they touch.

Let me tell you about a young boy named Suresh, who at five years of age began stumbling over the furniture, couldn't see the blackboard, and soon couldn't play outside with other children because it was too dangerous. Suresh's parents took him to a doctor who found he had cataracts. He was referred to Aravind's Children’s Eye Care Center. His mother Lata said:

"We are village people and felt doomed when my eldest child could not see. With very little money and very little hope in our hearts we traveled all the way to Madurai. All the time I was thinking: 'Will these doctors ask for a lot of money to save my child's eyes? Will he be forced into blindness forever?'" 

She thought her family was going to be poor either because their eldest son was blind, or because they would have to pay so much to help him see. Neither one. The surgery was a success, and it was free.  Suresh could see and play and learn in school like the other kids. Some time later, Suresh's younger brother developed cataracts, and he also had successful surgery, also for free. 

Wouldn't you like to be there just once when they removed the bandages, so you could see the smile of a child who just got his sight back?

In another instance, a 40-year-old husband and father living in a village near the Aravind Eye Center became blind in both eyes due to cataracts and began begging in the streets. He was referred to the Eye Care Center, had surgery, and recovered his vision. He then went back to his village, got a job in agriculture, and began supporting his family. He was so grateful to the center that for the next 28 years, until he passed away in 2000, he served as what they called a "motivator" volunteering his time to convince very anxious patients with cataracts to undergo eye surgery.

The man whose idea made this possible for millions of people, Dr. V, passed away in 2006. He is succeeded by Dr. Nam.

Dr. Nam has set a goal for Aravind of performing one million cataract surgeries a year within the next five years, a nearly four-fold increase from the staggering volume they already perform today.

Helen Keller once said, "There is no better way to thank God for your sight than by giving a helping hand to someone in the dark." If Aravind keeps growing as they intend, there will be no one left in the dark. 

For their magical gift of restoring sight, and for the guidance and inspiration they give to people doing miraculous things, I am proud to present the 2008 Gates Award for Global Health to Aravind and its chairman, Dr. Nam.