Dr. Bharatendu Swain, the visiting plastic surgeon, has been at Aravind for half a day and is still reeling from the wealth of information he has received, but his stream of questions continues unabated. He is now with the administrator of Aravind-Madurai—Dr. Aravind. Revisiting the issue of scale, Swain describes chasing the Indian government for two years in hopes of obtaining free land to expand his charity work—efforts that were in vain. “What is an appropriate size for me to aim for now?” he asks.

“We started with 11 beds,” Dr. Aravind says with a smile. “I’d say, do a pilot, and if that works, then build off of it. For us, scale has always come later. Building in phases is more practical. Your ...

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