See, Craig

Medicine

India

The Aravind Eye Hospitals in Madurai, India

The Aravind system is the world benchmark for sustainable, high quality, low cost eye care on a very large scale.  It offers unique clinical and research opportunities.  While at Aravind, I will learn low-cost ophthalmic surgery, which is a special technique I simply can't learn in the US.  Learning this surgery is a pre-requisite for performing cataracts in the developing world.  I will also work in high volume clinics with pathology not seen in the US, experience the efficiency of the system and make contacts within the Indian academic community.  Because of the scale of their operation, Aravind has been a major center for clinical trials in ophthalmology over the last 10 years, such as the Steroids for Corneal Ulcers Trial.  Aravind has a long history with Johns Hopkins, and Wilmer residents are some of the only residents in the country that are welcome there.  This elective is an opportunity I simply don't have in the US, and is instrumental in achieving my training goals.

The taxi cab merged to a chorus of honks.  Bicycles, motorcycles, tiny Indian-made cars, and BMWs shared the dirt road into town, constantly weaving in and out, chirping at each other but never colliding.  It was jarring and unlike anything I had experienced.  But traffic moved quickly, bicycle and BWM alike.  This was my ride to the Aravind Eye Hospital in Madurai, India.  It would come to represent my experience in India.

At Aravind I had the incredible privilege to learn small incision cataract surgery.  It is what allows Aravind to be so effective.  Cataract surgery in the US costs more than $3,000.  Small incision surgery can be performed for $7.  It’s something not taught in the US, because we have the resources to do the $3,000 surgery.  However, it is preferred in certain cases; I have a case of small incision surgery scheduled next month.

Ironically, a hamburger chain provided the inspiration for Aravind.  Dr. Venkataswamy postulated that if McDonald’s can produce a consistent, cheap product billions of times across the world, cataract surgery could be similarly reproduced.  The result is the largest eye care system in the world.  Beyond providing quality care, Aravind is committed to provide free care.

Every surgical fee in the “pay” hospital funds two surgeries in the “free” hospital.  The “operating theatre” consists of four operating tables and two surgeons.  Surgeons finish their cataracts in under 5 minutes while a new patient is prepared on an adjacent table.  The process is a flurry of activity to bring the patient, verify the identification, sterilize the eye, place a speculum and drape, place a bridle suture, and prepare a new kit of surgical instruments.  The surgeon turns to the new patient, rubs his hands with alcohol, and performs an abbreviated surgical timeout.

What India lacks in money they make up in human capital.  The key to Aravind’s success is the “sisters”.  They are girls from local villages who apply for the coveted positions within Aravind.  After selection, they are assigned to a particular role: opticians, surgical technicians, surgical counselors, etc.  They receive intensive training and soon master their role.  During my surgeries, it was common for a sister to notice something I hadn’t (and I was using a microscope).

The surgical experience I gained in India will be helpful for my future interests in international ophthalmology.  But the perspective gained from working within the Aravind system, its flexibility, its obsession with quality and cost, and its creative approaches, that may be the most valuable going forward.  

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...
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November 2017

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