Blindness by cataract is curable, but there is a huge backlog of cataracts in India.

The picture somewhat complicated: While the backlog is actually growing, there is some evidence that the rate of growth is slowing. Indeed there are areas in which cataract has pretty much been eradicated - these are around cataract treatment centres like the Aravind and Disha hospitals that specialise in high volume, low cost, high quality surgery. These centres are regarded as models for how to deal with the cataract backlog in developing countries.

One problem is that these centres are not widespread - partly due to India being such a vast and populous country, but mostly due to dearth of good management in my opinion. To address the problem, Aravind is now arranging for courses in eye hospital management to try and spread their methodology throughout India. I think that having such centres running throughout India can solve the problem - provided the requirement of good management is met.

Now, most eye centres do not have the characteristics of the Aravind/Disha way of doing things, (ie most don't do such high volumes AND low cost AND high quality). I will call such eye hospitals Non-Aravind Type Hospitals (NATHs) for convenience. While there is no doubt that NATHs are helpful, it is nonetheless true that there is a fine ethical line they sometimes tread. The issue gets complicated by the fact that they get charity donations to fund operations for poor patients.

In practice, what happens is that ophthalmologists fresh out of their postgraduate course gain cataract treatment experience by using charitable patients as their guinea pigs - they are less likely to sue after all. Now, under supervision of an experienced surgeon there is no harm - but there is no formal provision for training and evaluating these fresh surgeons, so there are hospitals where dismal results are achieved. Rural government hospitals are sometimes notorious for this. Not only that, the relatively low volume handled in NATHs is failing to make a dent in the cataract backlog in most of India.

So, perhaps a pilot project could be done as follows: during the 2nd-year (of the three year medical postgraduate course in ophthalmology) there would be a mandatory stint where the student has to go out for a couple of months and be trained and evaluated in cataract surgery in a rural hospital. This would count significantly to the final degree. Evaluating how this affects the cataract backlog in the area would be the aim. If it seems to work well and be cost effective, why not continue and expand it? If it seems to be a failure - then drop it.

I am unsure about how well this would work out in practice. It would have to be planned very carefully and be constantly and competently monitored and fixed to work well. While the problem of getting good management will be there, at least good cataract surgery training would become a standard, and perhaps there would be a greater chance of the Aravind model being replicated in rural areas due to the exposure of medical staff to these places.