Something this internship has made me question is what exactly makes someone passionate. When someone truly loves their work, and comes away each day with a sense of fulfillment, what is driving that passion?
At first I thought about friends who are artists, who spend hours pouring their hearts into a piece of art through the medium of pastel or graphite or pencil, and I considered what inspires them each day. Those people start with nothing, a blank canvas, and make it into something human, entirely unlike any other creation. These are creators, sane people that find fulfillment from expressing their thoughts and emotions in a way almost entirely unique to the human species.
Then there are doctors.
Most healthcare professionals take the mold of solvers. They start with a patient who has some sort of problem and take on the arduous task of fixing that patient’s problem. Doctors need a willingness to solve problems. And this is especially true of doctors at Aravind. No patient would walk into one of the specialty clinics at Aravind without having a serious problem that only a specialized doctor with years of training could solve.
Solvers derive fulfillment from providing resolution to something that they feel is wrong. Someone who goes to fix an issue is mainly driven by emotion about the issue, some mix of disliking the problem and liking the solution. Although a solver doesn’t like the problem at hand, she has to immerse herself in the problem to get rid of it.
Doctors have a compulsive desire to make people well, yet they’re constantly surrounded by people who aren’t well. To add to this, patients are likely to withhold helpful information due to shame or fear, in addition to refusing beneficial treatment for a variety of reasons. All this happens while doctors often work too many hours to maintain both a personal life and a healthy sleep schedule. When I consider all this, I understand why most doctors in the glaucoma clinic at Aravind are standoffish for the first exchanges of conversation, but become more friendly as they transition from their doctor role to a regular person taking a break.
Despite all the negative aspects of becoming a healthcare professional, thousands of medical school applications come flying in to universities every year. There are those who want to repair the health of other people to such an extent that insomnia, intense pressure, and low pay cannot veer them off their path (although those are serious issues that should perhaps be discussed somewhere else).
In my time in the glaucoma clinic, I’ve been surveying patients on a few aspects of their experience at Aravind. The three topics I assess are their knowledge on glaucoma, their feelings toward different parts of the hospital, and patient demographics. Although there have been a few surprises in the data I’ve collected so far, there is one question that I consisently hate reading. There are three questions on medication adherence which are, “Do you ever not take your medication?”, “How many days a week do you not take your medication?”, and “Why (if ever) do you not take your medication?”. The last question comes with a set of choices, where “forgetfulness” is the most common choice.
However, as I’m interviewing English-speaking patients, or when I read surveys filled out by Tamil-speaking patients, I always pray that the fourth option on the question isn’t circled. The fourth option is “I can’t afford to always pay for my medication”. Anytime I see a survey with that answer, I’m put into a sour mood for the rest of the day. I can’t shake off this feeling of injustice, that there is a sick person in the world who should have access to a bottle of eyedrops that costs $4, but doesn’t. Glaucoma as a disease is caused by increasing pressure on the eye, and any diagnosed glaucoma patient who doesn’t adhere to her medication is likely to see the disease progress and their condition worsen with each dosage missed.
The people who can’t afford medication typically come from a family that makes at most 5000 rupees per month ($75 USD post-Brexit crash), and purchasing a refill of medication might come at the cost of a pair of shoes or food for a few days.
However, these people aren’t the worst off economically. The largest barrier to visiting Aravind cited by patients is the time spent in the hospital, which could be better used to work for money or tend to farmland. There are almost certainly other people with eye problems who haven’t been able to visit Aravind because their eye health isn’t as valuable as a day of labor for their family.
This is a significant problem in healthcare, and something that I would like to work to solve one day. But what I came to realize is that if I get bogged down in thinking about the problem pessimistically, it will only make me feel worse and still nothing will be solved. If I stare into the abyss, all I’ll find is the abyss staring back. Optimism is the most valuable quality of any person who is solving a problem. Thinking about suffering and worsening is helpful to identify what’s wrong, but one should look forward to see how the suffering can be lessened and how the problem can be minimized to nothing. If surveying patients and interpreting data to find the largest gaps in patient education is what’s best for solving this issue for now, then that should be my focus.
Historically, leaders in healthcare have faced seemingly insurmountable problems and conquered them against all odds. Dr. Venkataswamy led the Aravind Eye Care System to take on millions of cases of blindness. Dr. Vagelos (a graduate of Penn) led a campaign to subsidize and deliver medication to west Africa that resulted in an almost complete eradication of river blindness in the region.
For now, I’ll feel some bitterness when I see the fourth option circled on the survey, but I’ll hold onto the memory of a woman donating boxes of medication to an eye examination camp I attended at a rural village just a few weeks ago. I’ll keep the problem in my mind, but my next thought will always be, “How can this be solved?”