Successful and Schizophrenic. This is an interesting op-ed by a self-proclaimed, successful schizophrenic who was granted the Genius Award by the MacArthur Foundation. The media has often either villainized the potential violence of those who are mentally ill or romanticized it in its depiction of mad scientists or musicians. This article reminds us to differentiate a diagnosis from a prognosis.

India’s Aravind Eye Care Center

Atul Gawande suggests that the Cheesecake Factory restaurant chain — with its size, central control and accountability for the customer experience — could be a model of sorts for health care. Interestingly the world’s largest provider of eye care in India has found success by directly adapting the management practices of another large enterprise, and one that is not often associated with good health: McDonald’s.

In India, 12 million people are blind, the vast majority of them from cataracts that tend to strike people in India before 60. Blindness not only robs these people of their ability to see, but of the possibility of joining the workforce, leaving them dependent or homeless. Dr. Govindappa Venkataswamy created the Aravind Eye Care System, which began as an 11-bed hospital, but has now become a large and successful network of hospitals, clinics, community outreach efforts, factories, and research and training institutes in south India that has treated more than 32 million patients and has performed 4 million surgeries.

Many health nonprofits in developing countries rely on government help or foreign aid, which was often the case when for many of the non-profits and NGOs in southern India, the poor provinces in Argentina, and in the townships of South Africa. Aravind’s main services, however, are sustainable because patient care and the construction of new hospitals are funded by fees from paying patients. Since Aravind works with the effiency of an assembly line at a factory, it allows paying patients to subsidize the ones who cannot afford to pay for treatment while still maintaining low prices. The high volume of patients is key because it allows fixed costs to spread among many people. Although Aravind’s model of care is not ideal for many diseases it can be applied to simple procedures like male circumcision, which decreases the rate of transmission of HIV.

What is best about Aravind’s model of care, as opposed to many foreign NGOs or non-profits, is how refreshingly noncolonial it is. Aravind is run by Indian doctors and is completely sustained by patient fees. This makes it feasible for clinics of this nature to treat people in even remote, rural villages that the government may hesitate to fund.