The week before my birthday, I enjoyed cake almost daily through a series of fortunate events. First, a group celebrating a girl’s second birthday at Madurai Eco Park offered me two slices of chocolate cake after I walked by. The following evening, we went to Haran’s house (and ate chocolate cake) to celebrate the conclusion of his internship. Haran had been an intern in the quality and patient safety office since February, and he was usually the first one there and the last to leave. At work the next day, there was a a joint clinical meeting on needle stick injuries attended by every hospital’s top leaders and microbiology departments. Once the meeting ended, the mood immediately shifted as we celebrated the birthday of Dr. Kim (AEH Madurai’s CMO). Dr. Kim’s cake wasn’t chocolate, but rather a caramel K-shaped cake decorated with frosted stock images relating to hospitals and leadership. Finally, the day before I turned 20, my project guide Ushalini surprised me with cake (chocolate again) while the entire office sang to me. I tried my best not to tear up, but my eyes did get a little watery. 

The wish I made when I blew out the candles was just to keep feeling as happy, at ease, and loved as I did in that exact moment. I know there’s the superstition to avoid sharing birthday wishes or else they won’t come true, but the world has enough good to go around.

The day of my birthday, we took Saturday off to go to Courtallam (alternatively spelled Kutralam), which is nicknamed the Spa of South India. We first headed to Palaruvi Waterfalls in Kerala, where we could bathe in the pools and hike up the mountain to enjoy the stunning morning views. Aravind’s Tamil skills came in handy as he secured tickets at the price meant for locals, and the rest of us tactfully kept our distance. We also marveled at the monkeys as they deftly swung down the face of the mountain and provided us with lots of laughs.

After our quick visit to Kerala, we hopped from waterfall to waterfall in Courtallam. The waterfalls were all separated by gender, and every woman was fully clothed in the water while some men sported bathing trunks. The men aggressively shoved each other to get the optimal spot with the maximum water pressure, but the women were much gentler. Many made space and held my hand so I could bathe more directly under the torrential streams of water. Standing under waterfalls gushing from the mountains and being embraced by women from all walks of life was nothing short of a transcendent experience. I was especially touched by a girl called Azima, who took special care to make sure I was safe in the crowd at the Five Falls and could fully enjoy the experience with a new friend.

Our first longer group trip together was when we visited Coimbatore and stayed with Aravind’s family for the night. I cannot emphasize enough how accommodating Aravind’s mom, grandparents, and uncle were, and we are all extremely grateful for their hospitality. The next morning, we took the iconic Nilgiri Mountain Railway train from Mettupalayam to Ooty (Queen of Hill Stations. Also a fun name to repeat aloud). I stretched my head out of the window throughout the 5-hour-long ride, absolutely in awe of the stunning mountain views and the vehicle itself. People from every section of the train yelled in unison whenever we rode through a tunnel, and the whole experience was more magical than a Disney ride.

As the track climbed to a final elevation over 7,000 feet, the scent of the air gradually changed from sweet and floral to crisp and evergreen. The second sign of our increased elevation was the 50-degree temperature, and both the clear air and the cooler temperatures were a welcome relief from Madurai’s heat. Once in Ooty, we took a safari through the Mudumalai Tiger Reserve, toured a chocolate and tea factory, and explored the botanical garden. The chocolate samples were good, but the tea varieties we tried (cardamom, masala, normal chai, white, green, and ginger) really hit the spot. When driving back from Ooty to Coimbatore, we were able to try a famous restaurant called Courtallam Border Rahmath Kadai at a rest stop. Ironically, we didn’t eat at the original location in Courtallam because it was so crowded, but their nattu kozhi porichathu was the tastiest chicken ever. Even thinking about it now makes my mouth water.

Most recently, Aravind and I traveled with his mom to Tuticorin. This was our first time taking a train in the AC 2 class, which was only slightly more expensive than AC 3 and came with the perks of more vertical space between beds, more outlets, and privacy curtains. While we were hoping to ride the glass-bottom boat and go snorkeling at Tharuvaikulam beach, the water conditions made that plan impossible. This setback gave us more time to explore other parts of the city, and we still got our fix of an adventure on the water through kayaking. If Courtallam was for waterfall hopping, Tuty was for exploring various beaches and literally savoring life at a comfortable pace. Food savored in Tuticorin included neem berries from a tree by the V.O. Chidambaranar Port, calamari, poricha parotta, king coconuts, and Ganesh Bakery’s famous cashew macaroons. 

Back in Madurai, I’m now much more comfortable with the lack of sidewalks and pedestrian-friendly crossings and have been exploring the city as much as possible after work. College has conditioned me to think everything is walkable enough, and I actually feel much safer on the streets of Madurai than in the US. I definitely get some stares and double takes, but I also get a lot of waves, hellos, and smiles wherever I go. My favorite location for a walk is the Vandiyur Mariamman Teppakulam, which is a large temple that comes to life at night. Of course, there’s no shortage of other temples to admire, and I also really appreciate the vibrant colors of all the buildings here.

Exploring the city with Sylvia, a Stanford student studying Tamil in Madurai for the summer, has led to many spontaneous adventures. One restaurant that I highly recommend is Ayyappan Dosai Kadai. Our server was the restaurant owner, the chef making all our dosas was his wife, and the lady greeting us from the counter was his mother. Sylvia and I didn’t order anything ourselves, but he brought out countless flavorful dosas to see our reactions once we tried them. At the end of the meal, he gave us a generous discount because we were foreigners and therefore his family’s guests. Our entire dinner cost only 80 rupees per person, which is ~$1. To be fair, every time I see the bill at a restaurant, I feel like I’m paying way too little. And luckily for us, the exchange rate has kept shifting in favor of the dollar, so it’s not like we’re getting ripped off at any other restaurants. However, no other restaurant has given me the special “family” discount, so Ayyappan Dosai Kadai will always have a soft spot in my heart.

On another one of our evening excursions, Sylvia and I saw two young female tourists by the Meenakshi Temple, and in our excitement I almost ran off with my glass of fresh pomegranate juice just to say hi. There’s very few foreign tourists here, and even fewer of them are young women, so we were surprised to see them. We did eventually chase them down (not in a creepy way, I promise) to drink filter coffee together and chat. Clara, who’s from New Caledonia, had one tattoo in Hindi that translates to “always perfect.” When I asked about the tattoo’s meaning, she provided several funny anecdotes of times in India where everything was going awry. Each time, she would end the story with exclamations of “ah, always perfect!” She approached life with the attitude that no matter how disappointing an event seemed, she knew the outcome would be better than she imagined. In fact, perfection would often come as a direct result of the disappointments. While I am not as well traveled in India as Clara (yet!), I will definitely keep her catchphrase in mind wherever I go.

Unfortunately, it’s clear that not all problems can be waved away with a casual “always perfect.” The optimism of always perfect felt especially hollow in late June and early July. The overturning of Roe v. Wade and the Highland Park mass shooting were both beyond devastating, and they deeply affected my feelings of security in my body and the Chicagoland community I call home. Processing these events again, but from the perspectives of Indian news media, sent even more waves of anger and grief over me. Being in India makes it much easier to question the American status quo and dream of better alternatives. India legalized abortion two years before Roe v. Wade, and in 2021, India’s MTP Amendment Act expanded access to abortions to reduce maternal mortality. India has some of the strictest gun ownership laws in the world, whereas the US clings to the Second Amendment and has suffered hundreds of mass shootings this year.

Obviously, these two democracies are very different. One small example of these differences is the omnipresence of the current Chief Minister of Tamil Nadu, M.K. Stalin — yes, he was named after Stalin. M.K. Stalin’s image is pasted everywhere, even behind the counters in some of the street stalls or on the dash of an auto. His approval rating is also higher than many politicians in the US. I’m not saying that huge public posters of Joe Biden will save his approval ratings (sorry Joe). We don’t need to be that dedicated to politicians. But we do need our policies to be more dedicated to protecting people’s lives, and I think India offers some promising possibilities on that front.

Of course, no place will ever be perfect. Even the Constitution’s “a more perfect union” implied perfect to mean improved, not flawless. “Always perfecting” might be more appropriate than always perfect, at least when it comes to bigger issues. Lisani’s project is related to kaizen, or continuous improvement. This attitude is something that AEH engrains in its operations and can apply universally. No matter how advanced a system is, there will always be room for improvement.

With that said, I will close with a few (more work-related) highlights: 

• Grand rounds! These are mostly attended by PGs but are explained clearly enough for anyone to follow. Grand rounds have covered clinical cases of lupus, orbital cellulitis, retinoblastoma, craniofacial fibrous dysplasia, orbital schwannomas, and Sjögren-Larsson Syndrome. Beyond just discussing the diagnosis and prognosis, grand rounds are also pep talks and reminders to focus on patients first. On July 7th, the grand round was a commemoration of Dr. V and his mission. The commemoration meeting only lasted half an hour, and then everyone returned to work. 
• A fresh batch of village girls came to interview and apply for MLOP positions, which are a major source of personal and economic empowerment. Once they begin working, they can call home once a week and see family once a month. When the girls reach their mid-twenties, most will get married and leave AEH. Speaking with the full-time MLOPs, it’s easy to see how some can become burned out from the long hours and the distance from their families. The sisters also are not allowed to have phones, but they never fail to find other ways to stay positive.
• Touring Aurolab, which manufactures ophthalmic consumables for AEH and over 160 other countries. I was most struck by the sheer manpower (womanpower) of the workers as well as their intense focus on every detail. The building was full of signs reminding workers that “every 15 seconds, somewhere in the world, an Aurolab IOL (intraocular lens) is implanted.” I initially assumed Aurolab mostly makes IOLs, but they produce a wide array of other products like suture needles, surgical blades, drugs, and medical equipment. Aurofarm is another section of the campus with organically grown plants, strutting peacocks, and a building in honor of Dr. V.
• Meeting Karna in the Inspiration lobby of all places. His family business, Neu Micromed (not an ad), does an impressive job of manufacturing ophthalmic surgical instruments and medical furniture. Kind of like Aurolab, but in Ahmedabad. As Karna explained, it’s easier to start this kind of company in India than in other countries, and the supplies made are then exported to other LMICs. 
• Becoming more and more comfortable in the cataract department and the operation theater (OT). The synergy between all the staff (doctors, fellows/PGs, MLOPs, housekeeping, sterilization…) is beautiful. Even watching the surgical monitors is mesmerizing. I feel very lucky that as a project student, I’ve been meeting with people at all levels on both the clinical and the management side and observing many areas of the hospital to see how the pieces all fit together. Aravind has the largest cataract department in the world, so it’s a real treat to be a small part of it. More on this in a future post!