Sahiti Avula, The Harker School,Sankara Nethralaya Report: June 29, 2012
I don’t think I can express in words how nervous I was the day before I visited the Sankara Nethralaya Academy. As a 15 year old girl who has not tried many things out of her comfort zone, I was certain this would be a great challenge. I had heard many great things about this foundation from my parents, and although one part of me wanted to see what this program was like, another part of me was very apprehensive. This was the first time I visited Chennai, the weather was hot, and in addition I did not know a single word of Tamil. So to sum it up, I was almost 100% sure that I would be extremely uncomfortable both socially and physically. What I actually experienced was in fact the exact opposite of what I had predicted, and I’m still laughing at myself for feeling like I would be out of place, because I’ve realized at Sankara Nethralaya, it is impossible for anyone to feel out of place. My parents and I were greeted by a warm smile from Mr. Sivakumar in the PR department the very moment we walked in and enjoyed the hospital tour led by Ms. Sreedevi and Mr. Mahalingam, who had sacrificed their entire day just for us. When we went to meet Dr. Badrinath, the chairman emeritus, I noticed how simple and humble he was, and I knew right away I had come to an amazing place. The rest of the week I worked at the JCOC with Ms. Kumari, an excellent refractionist, and I really appreciated that she took the time to explain to me everything she was doing to the patient. Mr. Sivakumar at the JCOC also inspired me to pursue my dream of becoming a doctor and he would always encourage me. Everyone was so friendly and welcoming, and I made friends easily. The next week when I visited the Teleophthalmology center, Dr. Sheila John made sure I got the best opportunities. Dr. Sheila John was extremely hospitable and ensured that I was comfortable and ate well. She also explained about the goal of the department in reaching out patients across India, Africa and Europe as well as the research that is currently ongoing to serve patients in remote areas even more efficiently by applying mobile phone technology. She introduced me to her staff of optometrists, and they were very friendly and hard-working. I went to Thiruvallur on a camp with them and I enjoyed it thoroughly. I’ve fallen in love with this wonderful foundation, and I promised myself that I would come back year after year and contribute as much as possible.
The first and most interesting place I saw was the JCOC. On my very first day, I was awed by the organized process every patient went through. The first test I saw was the DBR test. A patient was undergoing this test so the doctor could find out the power of the intraocular lenses. I observed that the patients were of limited financial resources, many were illiterate and several did not even have slippers on. I was so happy that Sankara Nethralaya was doing something so big for the patients who did not have anything to give to them in return. Ms. Kumari told me that 80% of the patients that visit are for cataract surgery because the cataracts easily form with aging. I also learned the names of all of the machines. When I used to go for regular eye tests in California, I never really knew what I would always put my chin on and press my forehead against. I know now that it is the digital biometer, and it is connected to the computer. Ms. Kumari explained to me that the scanning of the eye was called the A-scan and the ultrasound is used in this scan. The auto refractometer determines the power of the patients’ eyes so the doctor can find out the lense required. She explained to me that glaucoma is a silent killer of the eye and I was even able to look at a few patients who unfortunately had it. I was also fortunate enough to meet two wonderful interns, Pradipta and Usha, who let me examine the patients with them. The patients spoke Tamil, Telugu, or Hindi, so the optometrists were also required to know those three languages very well. On my second day, I saw a little boy whose right eye had been badly bruised by a ball a year ago. At that time, the doctors removed the foreign body in his eye by doing an intraocular surgery and he was told to come back after a year. His eye was much better and he was extremely happy. Every patient has their own file and the doctors have a very organized way of entering the information in and then converting it to a huge graph. 90% of the patients that come for cataract surgery have high blood pressure. Because a lot of the general health factors also affect the eyes, the cataracts are easily formed. Ms. Kumari showed me a fully-matured cataract in the eye of an older lady. The cataract had covered the entire eye and it looked like a mixture of green and brown. She was not even able to see how many fingers the refractionist held up just 15 cm away from her. I saw another lady whose cornea was thinning. An optometrist shined a flashlight into her eye and showed me the cornea. They ask the patient to look at a fixed point (the wall or their finger) and they take a tube-like device to measure the pressure of the eye. I watched Ms. Kumari first put some eye drops in the patients’ eyes and then run the device over their cornea. The device was connected to the computer, and it kept track of everything. The doctor held a knob which was attached to the digital biometer and nudges it forward. Each time it was nudged, a beeping sound was made, and this was the sound of the computer collecting the results from the device. I was amazed at all of the wonderful technology being used and the next time I visit, I would love to take a closer look at all of the machines. The patients need to get this procedure done so that they can report for their operation the next day. Before they sit down in front of the digital biometer, drops are put in their eyes. I thought that this was to clean or dilate their eyes. I observed that most of the patients had trouble following simple instructions like looking at a fixed point or opening and closing their eyes when they were told to. Because they came from remote areas, they did not understand what was going on and were not able to do what the doctors told them to. The optometrists often had to work hard to make the patients comply with the instructions. These patients were encouraged by the hope of glasses, and I could tell by the expressions on their faces that they were eager to be treated and cured. Even when the patients were speaking Tamil, I was able to understand a little bit of what they were saying because Tamil sounded so much like my mother tongue, Telugu. My highlight of that week was writing down information from the patients’ personal files to the huge graph where all the details were written down on. It was part of the clearance for surgery and I wrote down all the values for the DBR, including the K1, K2, K3, K4, AxL1, AxL2, age, sex, name, and identification number. The only things I was asked not to take note of were ACD, lens thickness, SRKII, EMM, and -1.00. I really liked doing that job for Ms. Kumari, because I was able to see what exactly is most important about the patients’ eyes before their surgeries are done. I also learned that "pseudophilic" meant that the patient had already undergone surgery in that area. I had to write pseudophilic for some of the slots in K3 and K4 because the patient has already been treated in those areas.
I noticed the next day that many of the patients had orange or yellow bands wrapped around their hands. Also for some patients, the optometrist asks them to read a certain line in a book instead of looking at the wall and reading the letters off of it. This was obviously to test near and far-sightedness. Most of the patients were myopic. I was also introduced to another machine which showed the optometrist the zoomed in version of the eye, but the other side looked just like a digital biometer with a screen that the patients are told to look into. I thought it was really fascinating how people came up with the structure for these machines. One of the things I found most interesting about this entire experience was getting to know the life of the patient. In a report I read, it said that 91.9% of the patients’ lives are much better after they had been treated. I saw a little girl who looked as if she was in about 5th or 6th grade walk in with her father. He was complaining because she would get scolded at school for not being able to read properly. She needed treatment very quickly. Later, Pradipta explained to me that rotitary nystagmus was her condition. She spent most of her time at the autorefractometer, because they needed to first determine the power of her eyes in order to get her treated as quickly as possible. The youngest patient I saw was a little girl named Swathi who was unfortunately suffering from the squint eye. I saw Kavitha, a senior optometrist, take care of her. Before a patient was tested, a pH solution was put in their eye so the doctor can see clearly. Because some of the patients’ eyes are extremely sensitive to the light, they wear sun glasses to protect them from the harsh light. If the patient has a fully matured cataract, the autorefractometer is supposed to inform the doctor the size of the cataract so that they can make new lenses for them and also be able to remove the cataract.
My first day at the teleophthalmology center, I learned a lot. An optometrist, Pearlson Prabhu, patiently explained to me the possible diseases or problems which could occur in the eye, and explained to me very well the process every patient went through for their check-up. When I went to the camp at Thiruvallur with them the next day, I saw that the conditions were much worse than the conditions I had observed at the JCOC. Most of the patients in the village were physically or mentally challenged, and of course that was the reason that they could not travel to the JCOC for their check-up. There were four different stations, and I sat at the very last one, the counseling department with one of Dr. Sheila John’s optometrists. Since I already saw how the registration, slit lamp, and autorefractometer worked, I thought the counseling station would be the best use of my time. To my surprise, most of the patients spoke Telugu, not Tamil. I saw that most of the cases were cataracts and were caused because of lack of general health, high blood pressure, and diabetes (diabetic retinopathy). Some people from SCOPE were also there observing, helping, and taking pictures. The process was simple- first; the patient went to the registration and signed in. Then, they were led to the slit-lamp and went through a few simple tests that would be easy for them to follow. After that, they went to the auto refractometer where an optometrist determined the power of each of their eyes. Lastly, they proceed to the counseling department where an optometrist tells them exactly what their condition is, and what steps they have to take next. If they require surgery and do not have BP (which I noticed was pretty rare), they will be given a card that they can bring with them to the JCOC the following week. If they have a cataract and require surgery, but unfortunately have BP, they have to stay in the village because an operation will further deteriorate their health. If they do not require surgery at all, the optometrist will give glasses or medicine and then let them leave. Usually the majority of the patients require surgery because they live in a remote area and a good hygiene is very difficult for them to keep. When we came back from the camp, Pearlson showed me the EMR and how and what information was entered into the graphs. These were important medical records and he helped me understand how the entire process works. He also showed me the teleopthalmology website and I’m so happy that even when I go back to California, I will be able to go through the website and discover new things which interest me. I could go on to write an entire novel about how much I was able to learn in just two weeks and I now know that the next time I come to India, I will definitely set aside at least a month to come back and learn more.
On my very last day, I was taken to a room in the main building where the optometrists injected a special red dye into the patient and looked at their cornea. The red dye helped the optometrist to see the exact blood vessels in the eye. They projected them onto a the screen of a big computer so that the could look carefully at any abrasions or damages. I saw three patients undergo this test and I noticed that there were many problems with how they behaved. They were not supposed to eat anything an hour before the test because then they would feel giddy and throw up. The second patient threw up because she ate just 30 minutes before they injected the dye into her.
Before I left, I made plan with Dr. Sheila John to do an iPhone project during this next year so that I can come back next summer for a few weeks and present my data. I would also like to explore more ideas in the Teleophthalmology area because it really interests me, and I really enjoy working with Dr. Sheila John.
Meanwhile during my first night in Chennai, I had slept with my contact lenses on, my cornea had some abrasions in it, and I became a patient here! Dr. RDB patiently examined my eyes several times during the week and gave me some eye drops along with a prescription for glasses so I did not have to wear my contact lenses too often. I am actually glad I was registered as a patient although I had really come to volunteer because it helped me understand the process so much better.
Although none of these patients could pay for their treatment and were uneducated, the doctors treated them with as much respect and care as some of the richest patients who came in to be tested. The friendly and hospitable attitude of the doctors and the optometrists really impressed and inspired me, and I realized why Sankara Nethralaya had such an excellent reputation. I’ve whole-heartedly enjoyed every minute I’ve spent here and I will never forget the kind people I met. In this prestigious foundation, there was not a single optometrist or doctor who did not treat every patient like family, something that I would also do if I were a doctor. Throughout these two weeks, I was able to understand that Sankara Nethralaya’s mission is not to bring themselves money and fame, but to give people from around India one of the most priceless gifts possible- the gift of vision.
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