As Dr. Nam and the other founders announced plans to step back from active leadership, it became obvious that a new executive head for the Aravind Eye Care System had to be named and a new structure designed for upper management. But there was no clear plan for how to do so.

Dr. Kim Ramaswamy is the eldest doctor in the second generation of the family. As the question of succession moved to the fore, he had a discomfiting sense that if an answer was not found soon, Aravind would fall into a period of gradual indifference and disintegration. So in 2009, he wrote to the one person he was confident could help: Fred Munson, Aravind’s longtime friend and advisor. He requested Munson to make a special trip to Madurai ...

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