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UPWARD MOTION: OT talks with Dr Devendra Tayade, of the Aravind Eye Care System, about making the best use of limited resources.

Compassion and resourcefulness form a powerful combination at Aravind Eye Hospital in Madurai, a city with a name derived from the Hindu word for sweetness.

The hospital is located on the banks of the River Vaigai in an unassuming blue building that hosts more than 1.2 million outpatient appointments annually. Aravind Eye Care System employee engagement manager, Dr Devendra Tayade, explained to OT that employees are guided by three principles: never turning patients away, providing the highest quality of care and self-reliance. The values were set at the inception of the organisation by its founding members.

"The question, 'How can we provide better care to our patients?' or 'How can we do better?' will be raised at least once during all of our meetings," he shared.

Humble beginnings

The Aravind Eye Hospital was first founded in 1976 with a modest offering of 11 beds. A network of eye care providers has grown from the hospital to form the Aravind Eye Care System, which incorporates six tertiary care centres, six secondary care centres, six outpatient examination clinics and 63 primary eye care centres.

The network performs about 12,500 outpatient visits and 1500 surgeries daily. Dr Tayade highlighted that the desire to make the best possible use of limited resources has fuelled a creative approach at the hospital.

"While you try to work with empathy within the constraints, you also try to find another way. And that's when innovation happens," he emphasised.

Dr Tayade observed how Aravind Eye Hospital founder, Dr Govindappa Venkataswamy, instilled in staff the importance of creating efficient procedures, with well-planned systems making up for a scarcity of resources.

An emphasis is placed on recruiting the right people to work at Aravind and staff duties are regularly reviewed, Dr Tayade highlighted.

"Tasks that are routine and can be done by a person with lesser training or skills are shifted to them. Tasks that are not creating value are removed to make systems lean," he explained.

A sustainable system

Aravind Eye Care System staff are also mindful of the environmental impact of the organisation. Dr Tayade told OT that the carbon dioxide emission per surgery across the network is 0.6kg compared to 64kg in the UK. Items that might otherwise be discarded are used in another capacity. For example, worn bedsheets are reused as mats, used printouts are turned into note pads and phacoemulsification cassette boxes are attached to slit lamps or repurposed as stationery containers.

All of the Aravind Eye Care System hospitals are installing solar panels, while several have introduced decentralised waste water treatment systems to recycle water.

Dr Tayade shared that the Pondicherry hospital recycled 200,000 litres of the 250,000 litres used each day at the hospital.

The ophthalmic manufacturing arm of Aravind, Aurolab, is working to reduce the amount of waste generated through the packaging of lenses and surgical material. Dr Tayade, who joined Aravind Eye Hospital Hospital Madurai after a stint as an intern, told OT that the hospital had provided him with a fertile learning ground. "I've learned and grown in my role. Ultimately, when you see your work making a positive impact that motivates you to carry on and do better," he elaborated.

Improving lives

The potential impact of the care provided through the Aravind Eye Care System is far-reaching. Restoring vision increased the average life expectancy of patients, while reducing the number of disability-adjusted life years.

"After a person loses sight, the next thing they lose is their dignity. When they come to Aravind and get their vision back, they don't have to rely on anyone," Dr Tayade emphasized.

An eye on recycling

OT hears how one eye health company has tackled the environmental challenges of daily disposable contact lenses

More than 790,000 contact lenses, top foil and blister packs have been diverted from landfill through a scheme that encourages people to collect and post their daily disposable contact lenses for recycling.

Bausch & Lomb launched its One by One initiative in partnership with recycling company Terra-Cycle in November last year. Since then, more than 2100 kilograms of contact lenses and blister packs have been recycled in the US.

A Bausch & Lomb spokesperson confirmed that the programme is being rolled out in Australia, and several other countries are being considered for expansion of the scheme. Daily disposable contact lenses are often filtered out of mainstream recycling because of their size and packaging. The One by One partnership addresses this conundrum by encouraging consumers to use a free, specialised recycling service.

Contact lens wearers are encouraged to collect their used daily disposable contact lenses, top foil and blister packs in a small cardboard box.

When the box is full, they are encouraged to send the box to TerraCycle by printing a free shipping label that is available online. Once received, the contact lenses and blister packs are separated and cleaned.

The metal layers of the blister packs are recycled separately, while the contact lenses and plastic blister pack components are melted into plastic that can be re-molded to make recycled products. TerraCycle specialises in repurposing hard-to-recycle products.


OT talks with AOP clinical and regulatory officer, Farah Gatrad, about the Association's waste disposal guidance

The AOP has produced an online resource ( to help practitioners understand their waste disposal responsibilities.

AOP clinical and regulatory officer, Farah Gatrad, told OT that the guidance offered advice on how to dispose of waste safely in day-to-day Optometrie practice.

"As waste producers, there is a legal responsibility and legal standards that practices need to be following," Ms Gatrad highlighted.

The guidance covers general domestic, non-hazardous and hazardous waste, and also the disposal of sharps.

As well as specific obligations for each category of waste, practitioners are encouraged to separate clinical waste from general waste, and hazardous waste from non-hazardous waste. It is also important to store waste securely, hire a suitable waste contractor and keep appropriate records of waste disposal. Practices that failed to follow their legal obligation to safely dispose of waste risked serious consequences, Ms Gatrad explained.

"Not following these guidelines could raise concerns with the NHS and create issues around General Optical Service contract compliance," she added.

Following the right procedures reduces the chances of harm and infection that can arise through the careless disposal of hazardous waste. "Ultimately, its about safety and minimising risk," she concluded.

The AOP has a range of other guidance available on its website,

Above: Dr Devendra Tayade
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Title Annotation:LEAN & GREEN
Publication:Optometry Today
Date:Nov 1, 2017
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