Cataract Screening in Chennai Slum

Last Saturday I had the chance to experience a cataract screening in a slum of Chennai, carried out by Sankara Nethralaya (SN), one of the best eye hospital systems in all of India. Exhibiting the efficiency of a private company, yet funneling all profits into free services for the poor, unique non-profit hospitals such as Aravind, LV Prasad, and SN are a major factor behind the success of eye care and community eye health in India, catapulting India’s cataract surgery rate to about 5000/year/million population—about 10 times China’s current rate.

The screening was simple but efficient, carried out in a local church that acted as a sponsor. Patients moved from a registration table to a visual acuity and flashlight exam station, after which their results were recorded on a form and they were offered transportation to the hospital for definitive diagnosis and treatment. One, two, and three weeks after cataract surgery, patients are picked up and shuttled to the hospital again for follow-up and glasses. All free of charge. The sponsor system is an integral part of outreach screenings for SN; a sponsor (often a religious institution, corporation, or individual wishing to honor someone) will provide the facilities, feed the personnel (sometimes even the patients), and carry out publicity. Essentially they make the screening possible, and put it all on their own tab. “So why do people want to become sponsors?” I ask, trying to understand the incentives in this seemingly one-way arrangement. My host looks confused for a second, and then replies, “Sometimes people want to honor a loved one. Most of the time people just want to do their part to alleviate the suffering of the poor.” I’ve heard that line before, but there’s something about his voice that sounds sincere.

Following the screening, I was taken on a long tour (I’m talking about a good 2 hours of the administrator’s afternoon) of the Jaslok Community Ophthalmic Center, a branch of SN that focuses on community-based initiatives such as screening. The center consists of two sections: a paying section for patients who can afford it (it has A/C and some nicer waiting room chairs), and a non-paying section for patients getting free service. Profits from the one are funneled completely into paying for the other. The physical segregation is not something I completely understand (maybe paying patients need to feel that they’re paying for something extra), but I was assured that the treatment quality is the same.

The screening was… informative (trying to avoid terrible puns here but “insightful” and “eye-opening” keep coming to mind), but the real twist of the day came during a break in the screening session, when I met a couple of boys from the slum who offered to show me around. More about that in a soon-to-come post…

 

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