In August 2020, Dr S. Aravind, Chief Medical Officer (CMO), Aravind Eye Hospital Chennai (AEH Chennai)1, was a worried man. Typically, long waiting times for patients were expected to be a concern at an organisation with a high-volume, low-cost system like AEH Chennai. Instead, patient volumes had drastically decreased due to the Covid-19 pandemic raging in the state of Tamil Nadu, and the state capital, Chennai, had emerged as the most affected city in the state. Cataract surgery was an elective surgery, and most of the patients with eye diseases, which were not considered to be life-threatening, postponed their visits to eye hospitals. The travel restrictions and advisories related to the pandemic made travel difficult even for those who wanted to visit hospitals. Traditionally, Aravind Eye Care System (AECS) had reached out to patients through its well-known outreach programmes and eye camps. The pandemic had jeopardised the feasibility of that approach. Dr Aravind was mainly worried about how the organisation could continue working towards Dr V’s mission, “Eliminate needless blindness,” which was the foundation of AECS and had guided the organisation for more than four decades. His concerns stemmed from his recent observations that several patients on whom he had operated had very poor vision—close to blindness— due to postponement of surgery. The effects of the postponement were apparent. The number of outpatient department (OPD) visits and surgeries at AEH Chennai had, at a certain time, plummeted to 5% of the capacity of the hospital. Dr Aravind wondered how to handle the constraints in reaching out to at-risk patients and bringing them to the hospital during a pandemic so as to continue pursuing Dr V’s mission.
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