Reflections and Future Prospects

Now that my internship at Aravind Eye Hospital and the Lions Aravind Institute of Community Ophthalmology (LAICO) has come to an end, I continue to reflect on the experiences I had this summer and the many wonderful lessons I learned. I undoubtedly shed a few tears on our last day as we picked up our things and said goodbye to the staff members we had worked with all summer. I am known for being an emotional person, but really it was difficult not to be sad as we shut off the lights in our office and took our last walk together from LAICO to our rooms in Inspiration. I reminisced on our times at Aravind as we walked out.

Our work as interns this summer took place at LAICO which is the training and consulting partner of Aravind Eye Care Systems. The purpose of LAICO is to support and assist Aravind Hospitals through management training, research and capacity building. As such, our projects originated in LAICO but were meant to support the Aravind Hospitals. This meant that we had the opportunity to see both sides, the medical and administrative side, of one of the largest eye care provider institutions of the world.


When our group arrived at Aravind in May, we were given an orientation that introduced us to the kind of work LAICO does. We met with various staff members that informed us about a few assignments that needed to be completed. All four of us were given the option to choose a project that we felt best matched our skillset and expertise. From there we began our journey of learning to navigate work environments and professional interactions in India, specifically with the people of Aravind.


At the beginning of our internship, my co-interns and I always joked around about the free time we had. As Penn students, we are accustomed to always being busy and stressed that whenever our work here seemed to take a pause, we were unsure what to do with our time. We later realized that this free time was only a side-effect of our adjustment period; we were really learning how to be flexible with our schedules and mastering the art of being humbly assertive. As time passed, we adapted to the norm of having some meetings pushed back a day or two and being insistent with our co-workers when we had to meet a deadline. Eventually, we grew comfortable with walking into our supervisors’ office and personally asking questions or arranging meetings right then and there rather than sending an email and passively waiting for a response. Contrary to our belief, it was acceptable to just run into their offices and it helped us get our work done quicker. It took us a few weeks but we just had to get over our perceptions of what was respectful or professional and adjust to what was status quo in this institution.


Celebrating a birthday in the office with some of the LAICO staff

Towards the end of our internship, our “free time” disappeared and before we knew it, our 10 weeks were up. Our last few weeks working in LAICO went by pretty quickly as days began to fly by and we rushed to properly finalize our projects before we had to leave the country. On my end, I was excited (and nervous) to compile all of the work I had completed to explain to the various departments involved why some of the goals of my project had to be reshaped and why the project should be continued beyond my departure.


Allow me to offer some background information:


The mission of Aravind is to eliminate needless blindness and they seek to achieve this mission by offering accessible and affordable care. With their talent and dedication, Aravind can absolutely accomplish this goal, yet the issue remains that health outcomes depend largely on a patient’s behavior. A provider can offer great service but if a patient does not comply with treatments and does not adhere to medical advice, then the care given by the provider may not be effective. In order to ensure that patients are receiving the care they need and that Aravind if offering efficient services, the staff seeks to investigate how well patients are complying to treatment.


A few weeks before my arrival at Aravind, a medical student had just started an investigation on patient compliance in the retina clinic, specifically diabetic retinopathy patients. When she left, she passed on her work to me and my task was to complete the research she had begun while also expanding it to create a project on patient empowerment. As such, my project consisted of utilizing data from Aravind’s electronic medical records system to measure patient adherence to disease-specific treatments while also partnering with the clinic manager and doctors to draft possible interventions that may help raise patient compliance. The investigations focused on diabetic retinopathy patients being that diabetic retinopathy is the most common ocular complication of diabetes and the population of diabetics in India continues to increase. Without the proper care, this disease can lead to loss of vision.


Along with measuring the rate of compliance, I was interested in getting a better understanding of a patient’s behavior. Developing interventions to help raise patient compliance means attempting to positively influence a patient’s behavior which requires understanding a patient’s general health-related behavior. In order to do that, I decided to begin a research study that would implement the framework of the Health Belief Model. I was interested in determining what health beliefs diabetic retinopathy patients had, how that influenced their likelihood to comply to treatment and how we could possibly target or influence those beliefs to encourage a patient to be healthier. Fortunately, I received great support from staff to initiate this research and after drafting a survey, I began conducting interviews with the help of a member from the biostatistics department (who helped translate from English to Tamil!).


Some of the nurses I worked with in the retina clinic!

As you can imagine, 10 weeks is not enough to begin and finish such a large study. I was able to complete a pilot during my time at LAICO, but in order to do a full study, I must work from afar. Everyone involved in my research has agreed to partner with me virtually to continue and expand the study and help me collect all the data necessary. For me this means I have the wonderful opportunity to continue working with such an amazing institution even after I finished my summer internship!


As I settle back into life in the U.S., I remain focused on encouraging staff to continue expanding on the work I began while I was there. I recently finished some final reports I submitted that outline what I did and suggests how students who come after me can pick up where I left off. I am blessed to have worked with such an incredible institution and I am so excited to be able to remain in contact with my supervisors. I learned more than I could ever have imagined from my work, the staff, the functions of the hospital, my co-workers and the work environment. My time at LAICO is unforgettable.


On a hike with some of our supervisors

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About Lizette Grajales

I am a rising senior at the University of Pennsylvania, majoring in Biological Basis of Behavior and minoring in Chemistry. This summer, I will be interning at Aravind Eye Care Systems in Madurai.