Filling Big Shoes – Month 1 at Aravind

When I found out I was selected by CASI for this internship at Aravind, my mind was immediately filled with questions: What would life be like there? Would I be able to fit in? How could I, just a first-year in college actually make a difference in this massive, world-renowned institution? Based on quick searches of TedTalks done by members of the Aravind management and talking with past CASI interns at Aravind, I knew there were certainly big—no, massive—shoes to fill.

After a little over a month here, I most certainly have settled in and found a routine here. My project is slowly progressing, day by day, I have learned many of the ins and outs of the Aravind Eye Hospital (AEH) system, and have even made many close friends amongst the hospital staff, my project guides, and even fellow interns here at the Inspiration Hostel.

Learning, meeting, and doing—these are the three ways I’ve mainly been spending my time.

Working on my project at Aravind

Upon arriving at Aravind, there was definitely a lot to learn. While I was certainly eager to start on my project, it was fascinating first learning about all the inner workings of the system that I had previously only read about on the surface level. On our first day at LAICO (Lions Aravind Institute of Community Ophthalmology), the building where we work most of the time, we were first given a morning-long presentation on everything about AEH. One of the most inspirational parts of this was learning about the early history of AEH, and how Dr. G. Venkataswamy was forced to overcome so many hurdles in his own life before even coming to a point where he could start writing the first pages of the Aravind story. His tireless dedication to the core mission of “infinite visions”—preventing and treating eye diseases to create a blindness-free India was an invigorating inspiration for my own project here at Aravind. Learning about the nurses, or MLOPs (mid-level ophthalmic personnel), the main workforce that drives the AEH system forward, was particularly interesting. They are recruited straight out of high school, given a two year training, and then have a three year mandatory work period here. This raised many questions about their experience here that I was curious to find out more about. On our very first afternoon, we were thrown into the deep end with patient shadowing: accompanying a patient throughout their whole treatment process at AEH. It was amazing seeing everything we learned that morning actually in action, from patient registration to initial refraction and vitals check, to actually meeting with a doctor for consultation and finally counseling to help with treatment adherence.

By the end of the first week, I had honed in upon my project area. I am broadly interested in preventive medicine and in conjunction developing effective methods for screening and treating pediatric diseases, so I wanted a project in this area. Serendipitously, the AEH Pediatric Department was encountering a problem with their amblyopia patients. Amblyopia, also known as “lazy eye” occurs when one eye has a significantly higher refractive error than the other, eventually leading to vision loss of the weaker eye. Affecting almost 5% of all children in India, it is the leading cause of childhood vision loss here. It is also particularly difficult to effectively treat—the only proven method over the long-term is patching or covering the stronger eye to force use of the weaker eye. The main problem was that patients were not adhering to this patching treatment paradigm, and also not attending follow-up appointments to assess their progress. My project would be to analyze the factors causing this, and develop solutions to effectively improve treatment efficacy.

Still, my project seemed extremely daunting. How could I possibly create any effective solutions as a first-year college student when I was surrounded by leaders in medicine and healthcare delivery with decades more experience than me? Meeting my project guides, the main contact points who would be helping with my project, definitely helped assuage some of these fears. My first main project guide is Dr. Janani. She is one of the Medical Officers, or doctors, in the AEH Pediatric Department. My other project guide is Mr. Murugaraj, who works in the AEH DTP department, and mainly works on patient outreach and communication.

We first met as a small team so they could teach me about the problem in-depth and introduce me to some other key people in the pediatric clinic with whom I’d probably be working with on this project. Progress was at first quite slow—everyone, especially the medical officers, being busy with their full-time jobs, it was difficult to arrange any meetings with anyone, sometimes even my main project guides. Back at Penn, I’m used to emailing professors or TAs and scheduling time to meet with them. This clearly was not working here. This brings up one of the main differences in workplace culture I have experienced here—people were more than glad to meet with me if I simply walked into their office and asked my questions. While this would not be considered appropriate at home, it seemed to be the norm here, and once I started doing this more, I found it much easier to meet with people I needed to.

Over time as I started to get acquainted with AEH and became more settled-in, progress slowly started to pick up pace. With the help of my newfound friends and colleagues in the pediatric clinic, most notably Aruna sister (the head pediatric counselor), I began to start interacting with amblyopia patients and speaking with kids and parents about their concern. Based on my initial observations, I created a questionnaire in Tamil with the help of Mr. Murugaraj, and deployed this in the clinic to get a more detailed sense of amblyopia patients’ main challenges with treatment adherence and follow-up appointment attendance. Along with this, I also began working with the IT department to get access to a limited set of patient data in order to call patients analyze a broader sample set. As I began arranging more meetings and interacting with more people around AEH, I found that the experience became much more enriching, and my project started moving along significantly faster.

It is not just my project however that is part of the AEH experience. Two of the highlights are the Grand Rounds on Thursday evenings and Journal Club on Friday mornings. Grand Rounds consist of a presentation on a salient topic pertinent to the hospital, presented either by a Medical Officer or some Post-Graduate (PG) fellows. Some of the most interesting topics so far have been 3 case studies on retinoblastoma and conducting familial genetic screening as a method for early disease detection. They explained how Aravind is able to do this screening very cost-effectively, and even cited Penn as an example of an institution that does not conduct cost-effective screenings! Friday mornings at 8:30am (if I manage to wake up in time) consist of attending Journal Club, which is a discussion on a pertinent research paper on a different ophthalmology-related topic each week. These have also been really interesting and allowed me to learn about other areas that are not directly related to my project.

One last thing I’ll mention in this section is our visit to a nearby vision center (VC). VCs are Aravind’s model for conducting primary eye care. They are essentially small rented-out house-sized buildings in small towns around Tamil Nadu and are staffed by two MLOPs. These serve as the first line of eye care, being an initial point of contact and treatment center for patients with basic vision issues, from simple refractive errors to eye injuries. We visited a VC at Alanganallur, a town bordering the outskirts of Madurai that is famous for the Tamil bull-riding sport of jallikattu. Being very interested in primary care as the main model of effective healthcare delivery, I enjoyed talking with the MLOPs here and understandings the ins and outs of managing a VC both from a medical and a business perspective.

The people we’ve met along the way so far

One of the best aspects of living at the Inspiration hostel is meeting all the other guests who come to Aravind for different purposes. One of the closest friends I’ve made is Picard, an ophthalmologist who has been here for 11 months already. He has come to Aravind mainly to work with the other MOs in the pediatric department and plan the implementation of some aspects of the Aravind model back in his home country, Tanzania. Picard is extremely nice, funny, and just a joy to be around! Some of my favorite memories are going out with Celeste and him on a 6 AM Sunday morning run at Sundaram Park.

Another friendship I’ve made is with Chansa, another ophthalmologist who has been here for almost one year as well. He is also working with other MOs and is researching the AEH model as well, with the goal of implementing some aspects of efficient medical and surgical treatment of eye diseases back home.

Miral, a design intern from Madurai who is not staying at Inspiration but works nearby us in LAICO has also grown into one of our closest friends. She graciously invited us to her house for lunch one day, where her family welcomed us with their amazing hospitality and I had the best cheese dosa I’ve ever eaten!

Lisani and Srinath have also been great friends over these past few weeks—they are both MBA students at the Thiyagarajar School of Management in Madurai.

We also met Sylvia, a rising sophomore at Stanford who is here in Madurai for the summer to study Tamil. One of her main interests is learning languages—she extremely talented at this! After already learning other South Asian languages like Bangla, she took up the challenge of Tamil this summer. We’ve met with her a few times already, and it’s so interesting to learn about her process behind learning new languages and her experiences traveling to each language’s place of origin in the process of learning them.

Haran is another intern at Aravind who recently finished his internship—he very kindly invited us to his house to visit his family and friends. He also took us on a very exciting motorbike ride through Madurai back to Inspiration late at night!

Lastly, Krishna, who is an intern at Aurolab (Aravind’s in-house medicines and medical device manufacturing arm)—his father leads AEH-Pondicherry. Through several very late-night conversations, we’ve learned a lot about the AEH system and his own future plans in the U.S.

The travels we’ve gone on, and what we’ve done

In June, we primarily focused on spending time in Madurai in order to get to know this amazing city better.

Our first trip as a group happened to be to the AR Hospital, in order to visit the emergency room. Manya unfortunately got slightly bit by a dog as she was feeding it, so we went to ask for rabies shots. Suhaas and I learned a lot about the—let’s just say different—ways emergency rooms are run here. Some aspects were great though—I could not imagine getting a vaccine for the equivalent of 350 rupees back in the United States.

We also visited various restaurants around Madurai. Some of the best were Madurai Bun Parotta (perhaps Madurai’s most famous food), Phil’s Kitchen (a homely Italian place), Appams & Hoppers (Sri Lankan classics), The South Indian (a wide array of local food), and Barbeque Nation (a more Westernized place with and unlimited buffet and tabletop grill).

Another site we’ve visited in Madurai is the Tirumala Nayaka Palace, the former home of king Tirumala Nayaka, who ruled over Madurai and the surrounding areas in the mid-1600s. The ornate palace is amazing to see and experience, from gazing at the intricate, vibrant artwork on the ceilings to hugging the hundreds of massive columns that support the roof.

In the evenings, Suhaas and I have been using our membership at Spark Fitness, a nearby gym. We try to workout many evenings as a way to relieve stress and just have fun. It’s nice experiencing just a few vestiges of home like this amidst a city so vibrant and bustling as Madurai.

That’s all for now, folks—I hope you enjoyed, and stay tuned for the next one (coming soon)!

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About Aravind Krishnan