My first week and a half at Aravind Eye Hospital has already provided me with an understanding of why this institution is so highly regarded in the business and medical fields. Busra, Vivek and I had the opportunity to learn about the history of Aravind, particularly its founder, Dr. G. Venkataswamy (or Dr. V). Creating this organization during his retirement, he exuded a genuine, persistent desire to better society through the “elimination of needless blindness.” Out of the 15 million cases of blindness in India, about 75% of them could be treated or cured (that’s where the ‘needless’ part comes in). Dr. V’s objective of providing quality medical care to an enormous patient population seems ambitious until you meet the staff here. The tireless work ethic of the administration, doctors, and paramedics explains Aravind’s success as both a hospital and educational institution. What I find to be most amazing is that Aravind provides excellent care to all patients, regardless of income. Procedures such as cataract removal can allow an individual to continue contributing to his/her family’s income, which is crucial to the impoverished, village families that traditionally all live together. In India, mortality drastically increases with blindness, and the ability to repair a patient’s vision can end up saving his or her life.
One of Aravind’s greatest strengths as a deliverer of compassionate care can be accredited to a skilled workforce comprised of young women who traditionally start their training around the ages of 17-19. These women are selected from rural villages across Tamil Nadu and interviewed along with their parents in order to determine their fit in the program. They commit to five years at Aravind: two years of educational instruction and three years of work as Mid-Level Ophthalmic Professionals (MLOPs) or Eye Care Paramedics. The first year is primarily comprised of theoretical training, followed by practical training and labs. The women then complete rotations throughout the different departments, such as pediatrics, neuro-ophthalmology, and surgery. Each MLOP will ultimately specialize in a particular skill, such as record keeping, refraction, general vision testing, or surgical assisting. My project focuses on optimizing the current training materials for MLOPs, by improving more than 50 objectives and standardizing the curriculums across all of Aravind’s branch hospitals. My team hopes to revitalize the current lessons in order to encourage interactive classroom learning. I will also be creating new course materials for a basic introduction to eye microbiology, pediatric eye diseases, ocular emergencies, and ocular pharmacology. The team is hoping to release the new course materials to the incoming MLOPs in August, and this curriculum will be shared with training hospitals across the globe.
As part of orientation to my project, I had the opportunity to observe Aravind’s free outpatient clinic, allowing me to interact with the sisters (MLOPs/Paramedics) and doctors. One of the chief MLOPs, Lakshmi, has been mentoring me (and is now pretty much my mom). She has been working in the clinic for 26 years and ensures everything runs smoothly with her gentle yet effective leadership. The sisters show kindness and patience to every patient, which can be especially challenging, as there are significantly more linguistic barriers and mental handicaps in the patient population at the free clinic. In this clinic alone, the sisters somehow care for 400-700 patients in a single day, maximizing efficiency and quality of service. Monday is notoriously the craziest day at the clinic, and I enjoyed helping the sisters register over 700 patients in a matter of hours. The camaraderie between the sisters benefits the patients from an increase in communication and teamwork, and it also creates a positive work environment filled with laughter and warmth (quite literally-there is no AC in the free hospital) . Aravind’s success at accommodating such a large volume of patients can be largely attributed to a data-driven mindset, mentioned repeatedly in all of the departments here. The paramedics meticulously collect personal and medical information from all patients, create identification cards, and store it in databases for record keeping. This process streamlines the following steps of medical examination for each patient.
When patients arrive, they register using the process described above. They then take a basic vision test with one of the MLOPs and undergo a preliminary examination by one of the doctors on duty. At this point, the doctors determine whether further physical tests are needed or if the patient should go directly to refraction. The patients who need further examination will undergo duct and tension testing, as well as dilation to look for tumors, high blood pressure, or diabetes. According to the results, these patients will either be referred to surgery (often in the case of cataracts) or to a specialty clinic for issues such as corneal injury or glaucoma. I loved spending time in the refraction station, as it’s pretty incredible seeing children and adults react to having perfected vision for the first time. Those receiving corrective eyewear can purchase it at a drastically reduced cost at Aravind and pickup the fitted glasses within the same day.
The free clinic represents the ultimate contradiction of “orderly disorder”. I’ve become addicted to its atmosphere, and I’m planning on spending time there several days a week to help with registration and patient records. I’m now in the process of learning Tamil from the sisters and my “Functional Tamil for Ophthalmologists” book, because 1) my vocabulary consists of about 8 words that I can kinda pronounce 2) I want to look less confused when patients yell at me in Tamil and 3) I want to be able to communicate with the sisters more clearly since I’m going to help them learn a little bit of English. I now spend my mornings at registration, my afternoons observing various vision test stations, and the end of the day sitting on the floor of the medical records room with the sisters-in-training, filing away patient data. The last part is probably my favorite, as it involves chai and hysterical laugher at my terrible pronunciation of Tamil words (progress is being made but it’s slow going).
This week I’ll be starting to evaluate the preliminary lessons on anatomy and physiology as it pertains to the eye, and I will then develop a plan to enhance the current lessons using feedback from the paramedic staff and hospital resources. I will also begin collecting materials to form an outline for basic microbiology topics. Additionally, I will begin shadowing an Aravind-based neuro-ophthalmologist that I met at a rural eye camp.
Poittu varén! போய்ட்டு வாரேன்!
(My book tells me this means ‘goodbye’, but don’t ask me how to pronounce it)
Stats for Week 2
Autorickshaw trips: 3
Temples visited: 1
Cups of chai: Way too many
Naps taken at inappropriate times of day: see answer above
Amount of DEET applied: enough to destroy the local ecosystem
Elephant sightings: 0 (cough cough, Busra and Vivek)