My co-interns and I have now completed our 10 week internships at Aravind Eye Care System, and it is time I share with you what I worked on. My project involves raising patient education and awareness. Before I delve into the details of my project, I want to point out a key difference between the US and India that makes patient empowerment particularly important in India. When you go to the doctor for a certain problem in the US, you talk with your doctor and ask questions. Most people are engaged in the doctor-patient relationship and have legitimate conversations with their doctors about the issues they are facing. Whether or not you realize it, that brief 5-minute conversation about the side effects of your medication or the possible outcomes of a condition improve your care and make you more willing to take care of yourself since you are given some responsibility over your health.
Many patients in rural India may not have the same level of understanding about their conditions or the same access to resources to learn about their ailments. Health literacy is quite low in many parts of rural India where education and general literacy rates are not high. Furthermore, patients respect doctors to the point that they hand over all responsibility of their health to the doctors. Doctors are so respected in India that we stood up every time they walked in the room (they forgave us when my co-interns and I forgot). While that extreme respect for doctors shows the prestige of medicine in India, it can actually negatively affect some patients’ health outcomes. Since most patients do not put a lot of thought into doctors’ instructions and diagnoses, the opportunity for asking questions and gaining knowledge and information is lost.
I recently had the opportunity to present at the Aravind Journal Club, a weekly meeting in which a research article is presented and discussed. I chose a study that was related to my project about the association between awareness about Diabetic Retinopathy (a condition characterized by damage to the retina due to weakened blood vessels from diabetes) and attendance at eye screening. A somewhat unexpected result of the study that I presented showed that doctor recommendations are not necessarily associated with changes in patient behavior. Rather, what was shown to be important is the patient’s own awareness of their condition; those who were more aware about Diabetic Retinopathy were more likely to attend the screenings.
In a setting like Aravind where the large volume of patients that each doctor sees requires them to go quickly between patients, doctor recommendations are not necessarily feasible. To address this issue, Aravind has counselors in every department so that patients can seek further advice. Despite this, a large portion of patients do not fully understand the conditions that they face or see that treatment really is essential. If you don’t understand enough about the eye or your diagnosis, you can’t engage with your doctor or counselor about your condition. Your doctor inevitably has power over you and you may not have the opportunity to ask questions to take charge of your treatment. And if you don’t have control over your treatment, you are less likely to care and take care of yourself in ways that are necessary for prevention of progression or for treating your condition.
Enter my project involving raising patient education and awareness. Aurolab, a division of Aravind that is dedicated to manufacturing, has commissioned the production of 100 videos dedicated to patient education and awareness of eye care in honor of the 100-year anniversary of Dr. V’s birth (Dr. Venkataswamy founded Aravind as an 11-bed clinic in 1970). As part of this bigger project, I produced 10 awareness videos. In addition, I am editing patient education materials for the new Aravind website, as well as producing brochures and pamphlets. This is one of the videos I made about CVI, a condition that is not very well-known even among doctors:
The videos that I have worked on involve Cortical Visual Impairment (CVI), Awareness for Preterm Screening, Squint, and Retinopathy of Prematurity (ROP). I also worked with the Eye Bank team to produce videos about eye donation. Once I decided which topic to work on, I met with the relevant team in the hospital and discussed their expectations and requirements for the videos. I mainly used an animation software called Powtoon (which is extremely entertaining and fun) as well as Microsoft Powerpoint.
The work I did at Aravind was clearly outside my comfort zone since all my health-related work so far has been in research labs. Reading articles and looking into cutting-edge research is what I have previously enjoyed. This experience was an adjustment in terms of working with many experts with different specializations. Coordinating between mentors in LAICO and doctors in the hospital to get everyone on the same page without calling a meeting for every little thing was a challenge. However, these challenges helped me grow in terms of becoming better at communication and allowed me to meet so many people in the hospital. My time at Aravind conducting a project on my own about a topic that is highly relevant and meaningful has been rewarding to say the least. I’ve said this in other posts, but this experience has showed me such a different side of medicine, and I am so glad to have had it. I look forward to working hard to complete the rest of my project, and I am incredibly grateful to CASI and Aravind Eye Care System for this wonderful opportunity.
Some other updates:
- I got to watch a few cataract surgeries and the eye donation procedure which were super cool and interesting.
- We visited Thanjavur and Thiruparankundram. Thanjavur is famous for its architecture and there is a huge temple that is incredibly impressive. Thiruparankundram has a small cave temple that does not get much attention; we visited with a group called GreenWalkers that works to raise awareness about local monuments that are somewhat lost and forgotten. We went with a few colleagues and then the four of us climbed the whole hill all the way to the Shiva temple at the top.
- I met one of the two families in Madurai that speak my native language (Havyaka, a dialect of Kannada) and got to visit their home for lunch. Making connections through language is really awesome! I have been slightly self-conscious about my ability to speak Havyaka because the amount I use it has steadily decreased, but I spoke solely in Havyaka with them in all our interactions so that was really exciting.
- We went to our colleague’s house for dinner and ate some homemade food, which was a refreshing change.
- We visited Delhi and Agra. At Delhi, we saw the India Gate, the Red Fort, and Humayan’s Tomb. In Agra, we visited the Taj Mahal and got to see a marble shop where they use the same material the Taj Mahal is made from