gentle couple two ophthalmologists with one grand...

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gentle couple

Two ophthalmologists

with one grand vision

Drs Nam and Natchiar at Nithyatha, the memorial for Dr Venkataswamy in Madurai18

HC_Inside_Pgs_Jan_Feb13.indd 18 04/01/13 10:03 AM

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“There’s nothing gentle about me,” declares well known ophthalmologist

Dr G Natchiar, 70, Emeritus Director, Human Resources, Aravind Eye Care Systems (AECS), Madurai, as she challenges me to validate her statement with a snap opinion poll among friends, foes and family. When I persist and tell her that, like a pineapple, her tough exterior conceals a childlike softness, the second woman ophthalmologist in the country guffaws into a throaty laughter and agrees to meet me the next day. In contrast, her husband, the relatively unflappable and no-frills Dr P Namperumalsamy (widely known as Dr Nam or Dr PN), 70, the first vitreo-retinal surgeon in India and Chairman Emeritus, AECS, chooses each word carefully with the precision of a surgeon, and gracefully accommodates my request despite having to leave for the US the following day.

The six-foot tall and distinguished looking Dr Nam, something of a Clark Gable lookalike, is the recipient of a slew of prestigious national and international awards including the BC Roy Award (2006), Padma Shri (2007), Bill and Melinda Gates Global Healthcare Award (2008) and Conrad N Hilton Humanitarian Prize (2011). In 2010, he was voted by Time magazine as one among the 100 most influential people in the world. Yet for Dr Nam it is the Outstanding Humanitarian Service Award (2012), conferred by the American Academy of Ophthalmology (AAO) at their annual conference at the McCormick Convention Centre in

The overall vision of Dr G Venkataswamy, who set up the Aravind Eye Hospital in Madurai, sometimes overtook the personal ambitions of those close to him. And this includes the ambitions of his sister Dr G Natchiar and her husband Dr P Namperumalsamy, who were both pushed into ophthalmology. Now in retirement, the couple talks to Dr Nandini Murali about their association with ‘Dr V’ and their early days at the hospital

Photographs: Dr Nandini MuraliArchival photographs: Aravind Eye Care Systems, Madurai

Chicago last month, which is the most meaningful.

“Do you remember, Natchiar, how we used to frequent the centre when we were ophthalmology fellows in the US, picking up household items… I never dreamt then that one day I would receive this prestigious award at that very centre,” he muses, as his wife nods meaningfully.

To carry success and fame lightly is a gift. In 1976, Dr Natchiar and Dr Nam were part of a five-member core team headed by the legendary Dr G Venkataswamy, Dr Natchiar’s eldest brother (widely known as Dr V) who founded the Aravind Eye Hospital in Madurai. Inspired by his charismatic leadership, the ophthalmologist couple spearheaded the evolution of the hospital into Aravind Eye Care Systems, the world’s largest provider of high quality affordable and equitable eye care services.

“Eye surgery is an art. You work in such a tiny space, and if you create a beautiful job, the painting is worth so much money. You put pictures in people’s eyes. You paint them stunning flowers, their children’s faces, or lines that are clear and sharp. You paint a perfect vision,” says Dr Natchiar, sounding like a miniaturist.

Our rendezvous is at Nithyatha (Perpetuity), the aesthetic memorial for Dr V in Auro Farm, amidst 80 acres of greenery in a sylvan suburb of Madurai. An oceanic stillness and serenity cloaks Nithyatha like the early morning November mist. Located right opposite a banyan tree planted by the late Dr V, the expansive circular grey structure

with its interplay of light and shadow unfolds like the petals of the lotus. The sonorous strains of the organ played by the Mother of Sri Aurobindo Ashram, Puducherry, form a perfect backdrop as Dr Natchiar and Dr Nam reminisce about their eventful lives as ophthalmologists.

We are seated on a stone bench under the banyan tree that has a special significance for both. Like the banyan, Dr V was an overarching presence in the lives of his family members. Dressed in a rust and green Chettinad cotton sari, Dr Natchiar talks about her ancestral roots in an upper middle class agricultural family in Vadamalapuram village in Tirunelveli district in Tamil Nadu.

Dr Natchiar was the youngest of five siblings that included three brothers and an older sister. Her father, Govindappa Naicker, and mother, Lakshmiamma, were widely respected in the village. Despite having studied only up to middle school, Govindappa Naicker placed a premium on education. He was a Gandhian, and Gandhiji’s values were his way of life. Lakshmiamma, a robust farm woman with admirable leadership skills, and Dr Natchiar’s paternal aunt spun the charkha. Dr Natchiar says that until she got married she only wore khadi paavadai, and later saris, though she rues that most of her clothes were variations of just two or three colours and made her feel she was “dressed in army uniform”.

“As a child, I had to recite one verse from the Tamil classic Thirukural and a chapter from Sathya Sothanai

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(the Tamil translation of Mahatma Gandhi’s The Story of my Experiments with Truth) every day,” recalls Dr Natchiar. Her father died when she was just ten, and she then moved to Chennai to be with her brother Dr G Venkataswamy.

A curious twist of fate bonded the two siblings closely. Older to his sister by nearly 23 years, Dr V was a father figure and mentor. “Most people would ask if he was my father. Later even Dr Nam used to ask me, ‘Where is your father in-law?’”

It was an unusual childhood. Dr V was just 30 when he developed chronic rheumatoid arthritis and severe psoriasis that irrevocably redesigned the course of his career. Young Natchiar looked after the bedridden and anguished Dr V “like a mother”. Meanwhile Dr V’s frozen and twisted fingers aborted his dreams of obstetrics and gynaecology, making him choose ophthalmology instead. The siblings lived right opposite the Government Ophthalmic Hospital in Egmore, Madras, and Natchiar would wheel in her brother for classes at the hospital. She also assumed the responsibilities of running the household and looking after guests.

The sensitive young girl was not impervious to the stigma and discrimination directed at her brother. “People mistook his rheumatoid arthritis and psoriasis for leprosy. Sometimes we were not allowed into restaurants and trains. I used to cry myself to sleep on those days. How could people treat my older brother like that?” she wonders, still upset.

Yet life with her brother also had its enriching moments. Dr V expanded his sister’s inner horizons with inspirational stories about Swami Vivekananda, Dr Annie Besant and Indian freedom fighters, particularly Dr Vijayalakshmi Pandit.

“We had the world between us … I imbibed his lofty sense of values, self confidence and the importance of hard work and discipline,” says Dr Natchiar. One of her most unforgettable childhood memories was visiting the Nobel Laureate Sir CV Raman who had invited Dr V for a discussion on colour vision theory.

“But just before we left, Dr V insisted that we should have only coffee, as he felt that a full stomach would make us dull and unable to interact with the great scientist!” remembers Dr Natchiar, laughing at

For 41 years, I have donned every role from steno to assistant, travelling with Dr V to countless eye camps across the state. I was coached in every step. They were hands-on lessons in team spirit, treating co-workers with respect and connecting with people,” recalls Dr Nam, admitting that Dr V was the “strongest influence” in his life

Drs Natchiar and Nam sitting under the banyan tree planted by Dr V


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how she spent a whole day “starving” while her brother and Sir CV Raman were engrossed in discussion.

Inspired by Dr V and awed by the kind of “social recognition” accorded to doctors those days, Dr Natchiar, who describes herself as a “very average student”, chose to study medicine. Having completed his Master’s in ophthalmology, Dr V joined Madurai Medical College in 1956 where he established the Department of Ophthalmology and continued to work there until his retirement in 1976.

In 1958, Natchiar joined Madurai Medical College. One of her classmates, P Namperumalsamy, was a rather “quiet boy and a very good student” from Ambasamudram village in Theni district, Tamil Nadu. The only son of a landholding family who nevertheless realised the importance of education, Namperumalsamy was determined to support his family and educate his three sisters. He was a bright student, who waded through rivers in his village to go to school. He originally wanted to do engineering since he had a flair for maths, but a friend of his father’s convinced his parents that medicine was a better choice.

Namperumalsamy’s excellent school final performance got him a seat at Madurai Medical College. All through his undergraduate years, his focus was only on completing his course creditably so that it would be a passport for a suitable job to support his family. “There was no time for extra curricular activities,” chuckles Dr Nam. His academic performance and conduct attracted the attention of his Professor of Ophthalmology, Dr V, who was also Dean of the college at the time. Dr V saw him as a “suitable boy” for his sister, Natchiar. A follower of Sri Aurobindo and the Mother, Dr V sent a photograph of “the boy” to the Mother wanting her to sanctify the proposal. After what seemed a “long wait” of four months, it was returned with the Mother’s scrawled “Blessings” across the photograph. The wedding took place in 1965 and is the only wedding in the Aravind family to have the Mother’s approval.

Dr Natchiar wanted to specialise in paediatrics while Dr Nam was torn between general medicine or general surgery. But a caveat from Big Brother Dr V, who insisted that she specialise in ophthalmology, upset their plans. The additional clause was that he wanted

“We had the world between us … I imbibed his lofty sense of values, self confidence and the importance of hard work and discipline,” says Dr Natchiar. One of her most unforgettable childhood memories was visiting the Nobel Laureate Sir CV Raman who had invited Dr V for a discussion on colour vision theory

An early photograph of Drs Natchiar, Nam and V

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Dr Nam to take up ophthalmology too. The couple was stunned. In the family, however, Dr V’s wish was always final.

The reason for their resentment is not difficult to understand. Back in the mid 1960s, ophthalmology was considered rather unglamorous, the Cinderella of specialities, and therefore few in India specialised in it. But the incidence of blindness in the country was rather mind-boggling, as most of them were preventable (as in blindness caused by malnutrition and the lack of Vitamin A), curable (such as cataract), and often caused by refractive errors.

Dr Natchiar is candid that despite her respect for her brother, even she believed that he was “selfish, though he repeatedly convinced me that it was a promising field”. Yet such was their respect for him that she and Dr Nam joined the postgraduate course in ophthalmology at Madurai Medical College in 1965. “For Dr V, the issue was to address needless blindness and he saw Dr Nam and me as mere instruments to further his vision. Deep down, however, I knew he could see farther than any of us,” says Dr Natchiar.

The decision was not without hiccups. According to Dr Natchiar, she had to appease her husband who was irate over their deviated career paths, now poised to converge, and her brother who insisted that she abide by his wishes.

“No! No! I never wanted her to do ophthalmology. It didn’t seem a good idea to me, as I feared ego clashes. In fact we got married on the condition that we would specialise in different areas. But then Dr V came into my life and changed everything,” says Dr Nam.

For the next 11 years (1965-76), Drs Natchiar and Nam worked in the Department of Ophthalmology headed by Dr V, first as students and later as faculty. Dr Nam acknowledges Dr V as his first mentor. “He was an absolute stickler for perfection and punctuality and did not tolerate mediocrity. As a result, many of my colleagues were afraid of him and pushed me instead to take up tasks which would be directly supervised by Dr V. For 41 years, I have donned every role from steno to assistant, travelling with Dr V to countless eye camps across the state. I was coached in every step. They were hands-on lessons in team

Dr Natchiar, the inheritor of Dr V’s vision, at Nithyatha

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spirit, treating co-workers with respect and connecting with people,” recalls Dr Nam, admitting that Dr V was the “strongest influence” in his life.

Dr V imparted new meaning to the term perfection. As students, Drs Natchiar and Nam began their day at 7 am at the Government Rajaji Hospital (GRH), where they would work until 1 pm and were back again at 2.30 pm after lunch. They would later consult at Dr V’s private clinic until 8.30 pm and then go back home to prepare for their PG examinations. In fact, Dr Natchiar took her final PG examination just ten days after her first son Prajna (named by the Mother) was born.

“Even though it was a C-section, I flew to Madras with my elder sister Janaky and the ten-day-old baby to appear for my final examination. Dr V reassured me that I’d be fine. ‘Natchiar, pregnancy is just physiological, and not an illness,’ he said to me.”

Meanwhile Dr Nam, who evinced interest in retinal surgery, met Dr Morton F Goldberg, well known retina specialist from the National Institute of Health, Washington DC. Dr Goldberg was part of a team of American doctors visiting the eye department at GRH, in connection with a PL 480 grant project. So impressed was Dr Goldberg that after his return to the US, as Chairman, Department of Ophthalmology, University of Illinois, Chicago, he invited Dr Nam in 1972 for an 18-month fellowship in vitreous surgery and a course in diabetic retinopathy. Dr Natchiar

accompanied him for a fellowship in ocular pathology at the same institute. The stint with Dr Goldberg – Dr Nam’s “second mentor”, who was a “strong academic and a good teacher” – was professionally rewarding.

In the early 1970s, the University of Illinois was one of the 20 centres across the US for a pioneering nationwide project on the impact of diabetic retinopathy on the population and its treatment and management through laser surgery. When Dr Nam returned to India he bought a photo coagulator with his and his wife’s earnings as fellows, the first machine

“What my parents and the core medical team at Aravind did was true service at the cost of great personal sacrifice. Today, for most of us, medicine is a profession, not service,” says Dr Venkatesh Prajna, the couple’s elder son who is the Chief of Cornea and Refractive Surgery, AECS

of its kind in the country. In 1974, assisted by Dr Gholam Peyman, another Goldberg protégé, Dr Nam performed the first vitrectomy in India at GRH.

Meanwhile Dr Nam’s passion for vitreo-retinal surgery got a new impetus with the visit of the celebrated Dr Charles L Schepens and his team who operated at the eye camps organised by GRH.

Belgian-born Dr Schepens, a hero of the French Resistance movement during World War II (he successfully smuggled several people from France to Spain during the war), is the


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Dr Nam with one of his mentors, the pioneering vitreo-retinal surgeon Dr Charles Schepens, and Dr Natchiar


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father of modern retinal surgery. He established the world’s first vitreo-retinal surgery department and introduced a fellowship in the discipline at the well known Massachusetts Eye and Ear Infirmary, Boston, a teaching hospital affiliated to Harvard University. Dr Nam expressed his desire to enrol in the fellowship programme to further his surgical knowledge in the discipline. Dr Schepens, who had seen him operate, told him that he was already selected for the course, as two other members of the evaluation team who were present were also impressed by his credentials. A few months later, Dr Schepens sent a letter of invitation to enrol for the prestigious course.

However, the state government was unwilling to grant Dr Nam leave of absence for another 18 months once again. When they did not relent despite his reasoning that it was a “prestigious course”, Dr Nam resigned from his job to pursue his dream.

“It was unthinkable. I just threw away a secure job. When I informed Dr V, he said, ‘Great! It’s time we started a hospital of our own’.”

In 1977 Drs Nam and Natchiar left for Boston. While Dr Nam trained with Dr Schepens, Dr Natchiar specialised in neuro-ophthalmology. Dr Schepens was a “hard taskmaster whose insistence on details and exhaustive pre-operative work up of patients and careful post-op follow up” were standards worthy of emulation. Meanwhile, a year earlier, Dr V had established the Aravind Eye Hospital in Madurai. Dr Nam, who is one of the Trustees, came down from Boston to sign the Trust deed of the hospital. The main hospital was inaugurated in 1980 by Dr Charles Schepens himself and Dr Nam recalls that four years later Dr Schepens visited the hospital to check if he was doing well.

The sweat, toil, tears and self sacrifice of the founding members in developing an 11-bed clinic into an ophthalmic empire, Aravind Eye Care Systems, whose five base hospitals today account for 45 per cent of eye surgeries in Tamil Nadu and one per cent of eye surgeries globally, is now acclaimed as Best Practices by the Harvard Business School and the University of Michigan.

“What my parents and the core medical team at Aravind did was true service at the cost of great personal

sacrifice. Today, for most of us, medicine is a profession, not service,” says Dr Venkatesh Prajna, the couple’s elder son who is the Chief of Cornea and Refractive Surgery, AECS.

“Dr V was a visionary who inoculated all of us with his vision. He was a demanding chief who always led by example. Perfection was his mantra. He rewarded us not by praise but by creating more opportunities for growth. We surrendered to his leadership. But at that time, neither he nor we had any idea of the shape the institution would take. Everything just fell into place and the grand design slowly began to unfold,” recalls Dr Natchiar, who played a pivotal role in translating that vision.

Now life for Dr Natchiar and Dr Nam is all about recapturing “lost time”. In keeping with the family tradition, both of them have handed the baton to the next generation. In fact, inspired by his mentor Dr Goldberg, who dissociated himself from surgery so that the second in

line could be trained, Dr Nam gave up surgery many years back (as did Dr Natchiar) and last year even relinquished his post as Chairman of AECS.

For Dr Natchiar this phase of her life is a return to roots. Passionate about farming, she says she is more a farmer now than an ophthalmologist! Auro Farm is a tribute to her green vision. Her other passion is listening to the discourses of Vaishnavite scholar Shri Velukudi Krishnan and being part of his entourage for temple visits across the country. As for Dr Nam, his current passion is to integrate basic and clinical ophthalmic research at the Dr G Venkataswamy Eye Research Centre that is part of AECS.

“It’s no use saying that we must do things only if we are perfect. We’ve got to start somewhere and perfection will follow,” muses Dr Nam, sounding paradoxically very much like Dr V. And at that moment I see not two ophthalmologists but one grand vision.

“It’s no use saying that we must do things only if we are perfect. We’ve got to start somewhere and perfection will follow,” muses Dr Nam, sounding paradoxically very much like Dr V. And at that moment I see not two ophthalmologists but one grand vision

Inauguration of Aravind Eye

Hospital in 1976


gentle couple two ophthalmologists with one grand...

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