Millions of people in India suffer from blindness and other vision problems, but ninety percent of the problems are treatable - most Indians simply lack access to good quality eye care. The Aravind Eye Care System, located in the eastern state of Tamil Nadu, is the largest and most productive eye care facility in the world. It uses high-quality video conferencing and low-cost wireless technology to bring eye care to poor, rural communities.
The Aravind Periakulum rural vision center, Tamil Nadu, India
A video on the Aravind Eye Care System
Being Blind in India
"Being blind in a rural village in the developing world leaves a person in darkness and dependence, often unable to earn a living or assist in the duties of their household," declared William H. Gates, co-chair of the Bill & Melinda Gates Foundation. This is true for most of the 15 million blind people in India, where almost half of the world’s blind live. Most of the burden falls on India’s 600,000 villages; almost eighty percent of Indians who are blind live in rural communities where access to care is extremely limited.
Most of India’s eye care specialists are located in urban areas. This places them out of reach of most rural Indians, forty percent of whom live on $1.25 US a day and cannot afford to make the difficult journey, over poor road conditions, to the city.[1] Furthermore, ophthalmologists are in short supply in India, with only 12,000 serving a population of 1.1 billion people. Few of them have sub-specialty training for rare or complicated cases.[2]
Videoconferencing Bridges the Urban-Rural Divide in Eye Care
Videoconferencing with a specialist
The Aravind Eye Care System reaches remote villages through 50 rural vision centers. The centers are equipped with basic equipment and run by an ophthalmic assistant who performs basic examinations, prescribes corrective lenses and treats minor ailments, but needs guidance for more complicated cases.
After seeing the assistant, patients undergo a five-minute video consultation with an ophthalmologist at an urban Aravind hospital via web camera and special videoconferencing software. The ophthalmologist can diagnose and give treatment advice in real-time, thereby reducing travel costs and time for patients. If the specialist deems an in-person examination or treatment at the hospital necessary, arrangements are made for a visit to one of the Aravind hospitals, where care is usually free.
A rural Aravind vision center in Chinnamunoor, India
To hold video consults, a little over half the vision centers use a low-cost wireless long-distance network, WiLDNet. This was designed by the Technology and Infrastructure for Emerging Regions (TIER) research group at the University of California, Berkeley, for rural, developing regions.
In this setting, patients are more likely to make the long journey to attend their appointment at city hospitals, despite transportation and lodging expenses, taking time off from work, and needing a family member to accompany them. This is because a specialist has already confirmed the need for examination or treatment, says Eric Brewer, a UC Berkeley professor of computer science and director of the Intel Research Berkeley lab. Brewer's lab helped to develop the wireless network installed by TIER. Brewster says that many of these patients would not have otherwise attended their appointment.
The Wireless Technology Behind Video Conferencing
In order to use high-quality videoconferencing, Aravind had to address having no internet connectivity or slow and expensive dial-up internet that did not support high-quality videoconferencing at the vision centers. This is a common predicament in rural areas with low user-density.
In early 2005, TIER began collaborating with Aravind to solve connectivity problems by installing WiLDNet. TIER develops low-cost hardware and software infrastructure designed specifically for the physical, political and economic real-world conditions of developing regions. This low-cost but robust wireless network is also used in Ghana, Guinea Bissau and the Philippines.
A wireless tower atop of a vision center
“The information t echnology revolution holds tremendous potential for addressing problems in developing countries…Historically, though, most projects have been either too expensive or too technologically complex to be used in poor, rural areas,” says Eric Brewer.[3] So, when designing technology, TIER takes into account cost, deplo yment, power consumption and local level of technological literacy.“ Helping them do what they were already doing, but better,” meaning optimizing parts of existing systems and technologies, is key to making the projects sustainable, emphasizes Sonesh Surana, a UC Berkeley computer science Ph.D. student and TIER member who first scouted Aravind as site for the wireless network.[4]
The TIER Tamil Nadu network
WiLDNet signals can travel up to 50 miles between relay points, compared to 200 feet common with wireless networks in urban, industrialized areas. Relay points use directional antennas and routers located in line of sight of each other to send and receive the signals that reach up to 6Mbps, which is over 100 times faster than the vision center’s dial-up speeds.
Achievements and Challenges of Videoconferencing Using the TIER network, Aravind vision centers have conducted 100,000 video consultations over the last two-and-a-half years, and a little over a year after TIER began installing its system, 5 to 10 percent of videoconferencing patients (about 100 a month) reported significant improvement in their vision, usually after receiving cataract surgery. Aravind also conducted an evaluative study in 2006 that found that 85 percent of men and 58 percent of women who lost their job because of eye problems regained employment after receiving treatment.
However, the relative newness of video conferencing and the demanding conditions of rural, developing areas pose challenges. Frequent power outages of 10 to 15 hours at vision centers disrupt services. Additionally, physicians need more training and familiarity with video consults, since the practice is not yet integrated into medical school curricula in India.
This year, Aravind received high-profile recognition for its work; the organization was given the $1 million Gates Award for Global Health in recognition of exceptional health work in developing countries. It is the largest prize in global health.
[1] (2008) “New Global Policy Estimates What it means for India.” The World Bank, Retrieved November 8, 2008.
[2] V. Thulais Bai, V. Murali, R. Kim, SK SRivatsa (2207). “Teleophthalmology-Based Rural Eye Care in India. Telemedicine and e-Health. 13(3): 313-322.
[3]"New wireless networking system brings eye care to thousands in Indai" UC Berekeley News, June, 2006 www.berkeley.edu/news/media/releases/2006/06/06_telemedicine.shtml.
[4] Interview with Rebecca Laks, November 2008.
