Making eye care available for all

I was very blessed to be born in Auroville. My mother was working in the crèche when she got labour pains and I was delivered at the Health Centre. So even in those days there was quite a good health structure in Auroville. In fact, my name, Aurosugan, means ‘good health’: it was given me by a devotee of The Mother who was visiting the Health Centre at that time.

My young days were spent in Fertile Windmill and were unforgettable. I lived with my grandfather, Perumal, who was the watchman. He was not educated but he was expert in many things. He played music and he built the house where we lived. Life was very simple. We didn’t have electricity; our only source of light was kerosene lights. My grandfather did not have much money to buy lanterns, so he was upcycling long ago before it became fashionable. He used to take my medicine syrup bottles, clean them, make a hole in the cover, put a thread through it, fill them with kerosene and light them.

I helped him water the trees in Fertile Windmill. There was only one tap in the whole community, so we had to go there to fetch water. I remember how careful my grandfather was about preserving water. In fact, he designed a bio toilet which didn’t need water.

For ten years I lived like that. I didn’t feel deprived because everybody around was living like that: I thought the whole world was like that. However, my mother was not happy for me to be there, so after ten years we moved to Kottakarai Farm. But the memory of those years has always stayed with me, and it fostered my interest in sustainability.

I was fortunate to have my early schooling in the Kindergarten and Transition School. Later, I went to Udavi School. I did my higher secondary education in Pondy.

I did well in my exams. However, as I was the first person in my family to be educated, there was not much understanding about what the further options were. I actually wanted to become a doctor, but that didn’t work out due to financial constraints. But I wanted to do something in the healthcare field. At that point microbiology was really new and interested me as it combined science and health.

As I had top marks, I got a free scholarship to a government school in Pondicherry to study it.

My teacher there saw that I was better in administration than the laboratory work so she suggested that afterwards I should take an MBA in Healthcare Administration.

I did this in Madurai, where I also received a diploma in the Sociology of Health. During my MBA, one of the course projects I did was at the Aravind Eye Hospital. There I saw big pictures of Sri Aurobindo and The Mother; it was the first time I had seen such big pictures of them in years outside Auroville and Ashram, so I already felt a connection with the place. But I didn’t apply for a job there then, or search anywhere else. Instead, I wanted to return to Auroville. 

I came back to work at the Health Centre where I was born, and started volunteering there with Albert. He told me I was overqualified for the administration job, but I said I just wanted to get some experience. After a few months, he suggested I could get a job with the Sri Aurobindo Society because they were doing healthcare projects in the rural villages. They recommended I should apply for a fellowship in hospital management at the Aravind Eye Hospital in Madurai. It looked like it was decided by Her Grace that this should be my place for service and the practice of karma yoga. 

The Aravind experience

For the first five years I worked in administration, learning new skills. During this time, for nine months I was part of a team of doctors and nurses from Aravind who travelled to less developed countries, like Africa, to increase the skill set of their doctors and the efficiency of people working in eye care. I worked in a small hospital in Abuja, Nigeria and an outreach centre, and my job was to train people in administration and quality control.

Africa was an eye-opener for me in terms of the demand for eye care. Till then I had been working in the Aravind hospital, not in the community. But when I went into villages in Africa I was totally shocked. Hundreds of people would come to us and I could see immediately that most of them were blind, with white cataracts on their eyes. This is when I realised that things are different when you don’t have a hospital facility in easy reach or one which people can afford. How to solve that? I realised there was a need for outreach, to go to the villages with eye care teams. So we worked very hard, day and night, to train the African teams to do outreach and not leave out anybody in the wider community who needed their help.

This message, the need for outreach in healthcare, struck me very strongly from my African experience. It gave me a different perspective, the community perspective. This is actually the community model which I want to apply now in Auroville for the bioregion.

Environmental Sustainability

Around 2016, when the sustainable development goals were getting kickstarted, a guest from America who was doing a project on sustainable waste management came to Aravind, and I was tasked to support her project work. I was immediately attracted by her work: it must have been in my genes from my childhood in Auroville that one has to be sustainable.

However, I had not done any academics in environmental sustainability: in administration you are only trained in financial sustainability. But I learnt that sustainability had to include not only the financial, but also the social and environmental aspects.

At the hospital we were already covering social sustainability because we were serving so many people. But environmentally? It was then that I realised how much waste our healthcare was generating.

So then I started doing a lot of research into the topic. I studied not only waste management, but also water usage and the energy aspect of sustainability. When I started making small changes, like reducing and segregating the hospital waste, reducing water consumption and reducing patient travel, the higher management became interested because sustainable practices in healthcare were a very new concept at that time.

I had all these ideas about what I wanted to do. These included making a much greater use of solar energy. When I began work, our solar capacity in Aravind was just 10% of what we needed, but now it is 60%. We already had a decentralised wastewater system, designed by Auroville’s Centre for Scientific Research. I worked on using this water more effectively, monitoring the ground water table and generating data to reduce the water usage. 

We made a booklet on sustainable practices in healthcare, and all this got a lot of attention, not just locally but also globally. I conducted a first-of-its- kind conference on environmental sustainability in eyecare and published and presented papers at other conferences. The International Agency for the Prevention of Blindness took up this initiative and started a core working group on climate change, and I represented Aravind on this global sustainability group.

I have also received a number of awards for my work, and it was a proud moment when I was selected as an ‘International Eye Health Hero’ in 2019 to be one among three global young leaders invited to interact with Queen Elizabeth online on World Sight Day in 2020.

COVID in Auroville

After twelve years at Aravind I returned to Auroville. I’d always planned to do this but it took me that long because I had to repay the education loan I had taken for my postgraduate study. Every New Year I used sit under the Matrimandir Banyan tree and reflect on what I had done and needed to do next. In January 2021 I decided to come back and give my service to Auroville and see how my experience could benefit the community. I wanted to repay what it had given to me. I also wanted to spend more time with my wife and children (at Aravind I was working long hours, processing 3,000 patients a day). My bosses in Aravind were surprised and shocked that I wanted to leave when I was at the peak of my career there, but when I told them I needed to return to Auroville they agreed, because they also wanted to keep supporting Auroville, for which they had great goodwill. 

I began by working at Santé Integral Health Centre because they needed somebody specialised in administration to take care of the coordination work. After a few months, when the very serious second wave of COVID struck Auroville, I coordinated the management of the response. Among other things, we had to coordinate all the healthcare bodies within Auroville and outside. This was very challenging. People were calling me day and night to enquire about symptoms, or to enquire about the health of friends, or to tell me about people who were not observing quarantine.

It was great that many people came forward to help, but it was very tough for me because whenever I made communications about COVID or government guidelines we would get strong reactions. For example, when I communicated regarding the need for vaccination, I would immediately get people telling me, there’s no need, and why was I spreading such misinformation? If people had a different opinion, I respected that. But as a health provider I had to think of the whole community, so eventually we made the difficult decision to post the names of those who were COVID-positive so that their friends and neighbours would know.

However, some people were not even informing us they had the virus. I had to call them on the phone and say we had heard you were not well, but they would say they were totally fine. Only when they got much worse would they ask for our help. But the problem was not just with some of the patients; it was also with the health providers. Each centre had its own way of working, which was helpful, but they were not working together. This is why I thought I had one of the toughest jobs in Auroville at that time, because it was all about collaboration, about bringing people together. [For more on Aurosugan’s work during COVID, see Auroville Today # 386, September 2021]

COVID taught everybody in the world a lesson: even the health systems of big countries were under severe strain and sometimes broke down. It taught me that in Auroville we do not have an efficient healthcare system. We provide primary care but we don’t really have a place where people can stay as in-patients, we lack skilled people, our health facilities close around five o’clock, and you don’t know who to call beyond that. Also, we do not have collaboration with local hospitals like PIMS, which would really have helped us cope with COVID. And the coordination problem between the different health providers in Auroville remains unsolved.

All this means that we are still not better prepared to deal not only with epidemics but also with other health emergencies. We don’t have a proper response system, which means that in any emergency we will still be firefighting again. I shared some of my suggestions for improvements with the Santé team and working groups but I’ve no idea if they are being implemented because, soon after, I had to step down from healthcare coordination.

The Aurokiya project

But what to do next? When I came back to Auroville, I was not really planning to focus on eye care. But since I needed to sustain myself and was passionate about healthcare, I decided to do what I knew best, particularly because there was a big eye problem in Auroville due to people’s increased use of digital devices during COVID. At that time, there were no eye care facilities in Auroville, so I decided to open one up, and Aravind was happy to give support. I set as my goal the elimination of blindness in Auroville and the bioregion. This is when I thought of my African experience and how it taught me the need to reach everybody in the community, not just by providing a centre but also by going out into the villages, workplaces and schools to identify and treat problems early. Starting up a comprehensive eye care facility is not easy as the equipment is very costly. However, what I learnt from Aravind is that when one’s goal is good, the necessary support will follow.

In fact, I received financial support from the Foundation for World Education to set up a small primary eye care centre in Auroville called Aurokiya, meaning ‘good health’. I started with just a primary eye centre, with an optical shop and some basic testing equipment. At our current location in Arka, this is primarily supporting Aurovilians. I have been doing some outreach work from here but plan to expand my work more into the bioregion’s villages, with support from AVI USA and other supporters.

My plan is to reach the community through some kind of mobile van, go to the schools, the villages, the workplaces, do simple testing and provide at least provide 70% of the care the people need at their doorstep. For the remaining 30% they may need to go to hospital. We will provide free treatment as well as follow-up care because we will keep track each patient.

I’m always learning. Recently I met a guest who said I was doing a wonderful job but I could work more holistically to address the problem of eye care. He explained I should not just be concentrating on treating eye problems, but also on preventing such problems happening in the first place. This can be done by teaching ‘eye yoga’, simple exercises to relax and strengthen the eyes. The three mantras are ‘blink, breathe and believe’, and we have been actively working with schoolchildren on this.

I am far from achieved everything I want to do yet, and setting up Aurokiya has had its ups and downs. What does success mean for me? I want people to tell me that I have made changes and done a great job, and that if I hadn’t been here this would not have been possible. If this happens, I feel I will have fulfilled my full potential.

I believe that by doing something good you can grow, and if people see you are going doing a good job, you will always get support. And I’m sure Mother will always shower her blessings.

For more information on Aurosugan’s eye care project, contact [email protected] or [email protected]