Wang, Aaron

Medicine

India

During my elective in Aravind Eye Hospital in India, I will work with Aravind’s product development and manufacturing lab, Aurolab.  Aurolab produces low cost ophthalmic tools and implants to address the large number of patients in need of care but cannot afford it (e.g., intraocular lens implant made for $2 instead of the $700 in the US).  I will be working with Aurolab to refine my iPhone indirect ophthalmoscope prototype to reduce manufacturing costs, improve its ease of use, and to come up with a strategy for distribution.  I will also examine its uses in teaching and telemedicine.

At Aravind, I will also learn how to perform SICS (small incision cataract surgery).  SICS allows for high volume surgery at low cost, whereas in the U.S., the standard of care is phacoemulsification cataract surgery, which is what is mainly taught in the training programs here.  By learning SICS, I will be armed with a valuable surgical technique which I can bring with me to my future global work in underserved areas. Also, I will be learning about and managing eye diseases that are common to developing areas and uncommon here. 

I am eager to learn all about India’s health care system and its ability to address a large population efficiently and cost-effectively.  I am also excited to immerse myself in India’s culture, foods, and language.  

Host Institution: Aravind Eye Hospital, Cuddalore Main Road, Thavalakuppam

I arrived at Chennai Airport—my first time in India—at almost 9 pm December 9th, 2014. As I deplaned, I just followed the crowd out through Ebola screening, customs, immigration, baggage claim, and then out the airport to a sea of people with signs up.  I saw a driver holding a sign for “Dr. Aaron Wang, Aravind Eye Hospital” and at that time I knew already that this will be a great visit.  The first half of the 3 hour drive down to Pondicherry was all about dodging other cars, motorbikes, bicycles, pedestrians, cows, and dogs (all of whom thinks they have the right of way) in a very crowded road.  Neither the driver nor I had seat belts.  We arrived safely at the gates of Aravind Eye Hospital at midnight.  The guards opened the gates and the driver brought me to the guest house, where I found myself quickly in bed. 

The next three weeks of my stay was packed.  My goals were to understand the Aravind Eye Care System, learn how to perform SICS (small incision cataract surgery), help out at screening camps at remote villages, harvest eye tissues from the recently deceased, and learn about ocular diseases at the outpatient clinic that are common in India.  My days started early at 7am in the operating theater and afternoons are spent in the clinics which end at 6pm. From 6pm to 7am, I was on call to join the eye bank’s team to make runs out to those who just passed away and harvest eye tissue.  The volume of patients seen and operated on here was an order of magnitude more than what we are used to in US.  I picked up SICS relatively quickly; by the 4th and 5th case, I was able to perform the entire surgery without assistance.  However, it was probably beginners luck, as the next string of cases were not very smooth.  Fortunately, my assigned teacher was able to address my mistakes and ensure good outcomes for all my patients.   As my training progressed, I was able to become more independent, that the last few case, my teacher did not even scrub in.  SICS allows for high volume surgery at low cost, whereas in the U.S., the standard of care is phacoemulsification cataract surgery, which is what is mainly taught in the training programs here.  By learning SICS, I am now armed with a valuable surgical technique which I can bring with me to my future global work in underserved areas.

My other goal during my travel to Aravind was to work with Aravind’s product development and manufacturing lab, Aurolab.  Aurolab produces low cost ophthalmic tools and implants to address the large number of patients in need of care but cannot afford it (e.g., intraocular lens implant made for $2 instead of the $700 in the US).  I developed at Hopkins a head-mounted smartphone device that allows for videorecording of an indirect fundus exams for very low costs.  It costed $40 for me to make in a machine shop where as a standard indirect ophthalmoscope cost $3,000 and a video equipped indirect ophthalmoscope cost $10,000.  Aurolab is located in Madurai, which was an overnight bus ride for me from Pondicherry.  I spent 2 days in Madurai to demonstrate how to use my prototype and meet with the senior engineers at Aurolab.  We discussed how to improve its design and ease of use.  I used the device at screening camps (which usually take place at remote villages) and recorded fundus exams.  By doing so, patients were immediately able to see their fundus and any pathology on a smartphone.   The local camp organizers honored me with a silk scarf and gifts.  The engineers at Aurolab and the physicians at Aravind have found my prototype to be useful for teaching, telemedicine, and developing countries.  Hopkins technology transfer office is currently discussing with Aurolab strategies for IP protection in India, and manfucturing and marketing of the device. The advantages of my device over other smartphone fundus devices are that my is hands-free, intuitive to use (technique of performing the indirect ophthalmoscopic exam is preserved), and provides a large field of view and the ability to view the peripheral fundus. 

It was a busy (and quick) three weeks trying accomplish everything. Fortunately, I was also able to immerse myself in India’s culture, foods, and language.  I visited Auroville, historic temples, and Pondicherry’s beautiful coast.  Christmas was business as usual in the OR and clinic, but I was able to celebrate the night of Christmas Eve at the French Quarter and visited the cathedral there. I was soon back at Chennai airport on December 27th.  As India got smaller and smaller from my window seat view, I was very happy to have learned a lot about India’s health care system and its ability to address a large population efficiently and cost-effectively.  I look forward to my continued relationship with Aravind and Aurolab regarding the production of my head-mounted smartphone device. 

People

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Robert Bollinger Jr., MD MPH

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

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...
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October 2017

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