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Tim’s Adventures In The Aravind Eye Hospital

A tour of and around the Aravind Eye Hospital in Pondicherry, India

I must admit, I’m feeling rather proud of myself today; as I have mentioned before, I have a pretty severe phobia of anything medical. I spent a lot of time in hospital as a child, as well as a reasonable amount in the last few years and I hate it. I’m absolutely terrified of the prospect of going into any medical facility, even if it’s just Anna working there and she asks me to meet her for lunch, or if I volunteer to help out at a hospital fund-raiser I freak out, get cold sweats (it stinks, too), I start shaking, and I get all restless and fidgety. It’s not pretty. Now, I started this blog for three reasons:

  1. To help me remember this trip,
  2. To help me try to conquer the fear and anxiety I suffer due to my ‘White Coat Syndrome’, and
  3. To  create an informative, first-person reference for people who were considering coming over to Pondicherry to volunteer or train at the Aravind Eye Hospital.

So, why am I feeling so proud, you ask? Because, I bit the bullet yesterday and went out to the hospital and took a personalised, guided tour of their facilities, among other things. But not only did I get to see the inner workings there, I was also able to witness how the other 95% live here in Pondicherry, the real India.

Tuesday, March 10, 2015
Our journey to the hospital started at 8:00am. The hospital is only about 10km away, but it takes at least half an hour to get there due to the traffic in our tiny little ‘auto’ (the same as a tuk-tuk, a motorised, covered tri-shaw). The further away from our resort in Pondicherry’s small French Quarter we strayed, the more drastically the scenery changed. We have stray dogs in our area, hell, I saw a stray dalmatian the other night. We’ve also been to the other side of the canal and ventured into the Tamil areas, but just not this far. Our auto driver had both balls and brains of steel, our fearless charioteer through a maze of dogs, cattle, and unroadworthy automobiles of all descriptions, driven by some of the most reckless drivers I’ve ever witnessed. When we had first made the two-and-a-half hour trip from Chennai Airport to Pondicherry a week ago, I was nervous for the same reason. But now I know I was just being overly cautious; on that occasion our taxi had not only seat-belts, but doors keeping us in the vehicle. Also, we didn’t have to avoid potholes for fear of jackknifing on that trip, but today we did. Indian traffic is bad, but there are several factors that make it so. Drivers in South-East Asia are notoriously terrible, but take the driving ability, or lack thereof, of the worst driver from that entire region, put that person on every motorbike, scooter, or in every car and then just let them go for it. At its absolute worst, i.e. the end of the school day, increase the volume of traffic 10-fold. The general mentality is that the vehicle with the loudest horn has right of way, thus it is usually a size ratio: Buses, then cars and small trucks, then autos and, lastly, bikes. These are all trumped, however, by anything bovine-drawn, as cows are considered holy. Also, if a vehicle cuts another vehicle off, it seems it is then the responsibility of the vehicle that has been cut off to stop, because, well… no reason, really, they are just in the way now. Our driver must have thought all of his various Gods had his back, because he wasn’t giving way to anyone!

I am so glad to be staying in the French Quarter of Pondicherry, because the further you get out of town, the worse it gets. Walk around in Pondicherry for a few hours and you’ll see a few disheartening situations — Small slums, a canal you can almost taste upon approach, people begging for change and sleeping on the roadside, children looking you in the eye and rubbing their stomach. But this is about as ghetto as a Taylor Swift concert when compared to the outskirts. On the way to the hospital we crossed three rivers, all of which we could smell before we could see. Despite the attempts of several old women perpetually sweeping the streets, there is rubbish strewn around everywhere as starving dogs paw through the contents of old garbage bags and bins. To put it in perspective:


Approaching the Aravind Eye Hospital, Pondicherry.

But as you continue your journey, the stress begins to subside. Then, as if out of nowhere, the road becomes smoother and widens and lush greenery appears on both sides. Suddenly, rising up like Olympus out of this beautifully sculptured scrub is the Aravind Eye Hospital. Upon entering the driveway, you instantly forget where you were ten minutes ago. Aravind Eye Hospital was founded in 1976, by Dr. G. Venkataswamy, or ‘Dr. V’ as he was affectionately known. What began as an 11 bed nonprofit centre manned by four medical officers became what we see today, a centre that services an area with a population of 21.6 million people. To put that in perspective, the total population of Australia from the 2011 census was 21.5 million (21,507,717, to be exact). In fact, between April, 2011 – March, 2012, Aravind-Pondicherry handled 456,357 outpatient visits and performed 50,960 surgeries. While researching this post, I found this interesting little tidbit:

Aravind’s surgeons conduct 2,000 operations a year each, on an average. The number in the U.S. is just 125. The high number of surgeries, however, does not mean more mistakes or a compromise on quality. The number of complications at Arvind are nearly half of those in the British Health System for the same procedures. 

Mountains of paperwork

Mountains of paperwork

The Pondicherry building itself is a beautiful white and emerald, five-storey structure. Inside, the powder-blue linoleum of the hallways looks somewhat dated, but the facility is impeccably clean and sterile. As I entered, the first thing that struck me was the unbelievable amount of patient files! The hospital has digitised most of their paperwork, but still keeps hard-copies of files for all of their patients. With the sheer number of patients seen, this amounts to an extraordinary amount of filing to do. The biggest problem, I was told, is that due to the way Indian names are formed, they see an incredible number of patients with the exact same name. The same name can come up 20 times in one day, each time for a completely different patient!

For patients, there are two options, Paid or Free treatment. The benefits of paid treatment are quite simple: For a fee of ₹60 (approx US$0.95), the patient receives an air-conditioned waiting room and a commitment to be served within 90 minutes. For patients who choose the free option, their waiting room has a fan and a few windows open (remember the mosquitoes I mentioned in a previous post?) and there is a first in, first served policy. Also, if surgery is required, patients who opt for free care can only have manual, not laser surgery, and their wards are extremely basic. The hospital operates on a  ‘Robin Hood’ policy, where the profit generated from paying patients is then used to cross-subsidise and fund free surgeries for poor people, as opposed to relying solely on government funding.

Unlike other eye centres, to cope with the endless queue of patients, the ophthalmologist only conducts the tests on the patients, then analyses the results, diagnoses the problem, and decides on the best course of treatment. So the doctors can better utilise their time, there are specially trained counsellors to speak to the patient on matters such as compliance to medication or surgery. This speeds the entire process up significantly, as the ophthalmologist is left simply to do the important tasks. Yesterday looked incredibly busy at the hospital so I asked if it was an average day. My guide smiled and told me that it was a slow day, because in India it is considered bad luck to begin something on a Tuesday. The previous day they had seen 1,160 patients! A lot of ophthalmologists there work seven days a week and may not go home for two to three days at a time. They didn’t become doctors for wealth or status, they did it because they genuinely want to help people.

Just a small portion of the hospital's garden, with part of the rice paddy in the background

Just a minute portion of the hospital’s garden, with part of the rice paddy in the background

My tour concluded in the hospital gardens, which is possibly the most amazing part of the campus. As is common knowledge, tap water in India is undrinkable. In fact, it shouldn’t be used for washing fruit and vegetables or even brushing your teeth, as people have been known to get extremely sick from these simple, yet innocent, acts. Aravind-Pondicherry boasts one of Asia’s largest waste-water treatment plants and uses the end product to sustain the hospital’s vegetable garden and paddy fields. As a matter of fact, more than 50% of the food served in the hospital, both to staff and patients, is grown on the campus, but it definitely helps that the menu is almost solely vegetarian. Everything served is absolutely fresh and organic.

A few other points of interest about the Pondicherry campus of the Aravind Eye Hospital:

  • As I just mentioned, the food served there is really good:

Yesterday’s lunch. it might not look like much to some, but it tasted great!

  • When dealing with patients in remote areas, one technique that was pointed out to me was telemedicine, where images of the eye are sent to the doctor via webcam:

In case you’re looking at the image on the computer screen, the person had just got out of the chair.

  • When giving me my guided tour, I was told that one of the best, yet simplest, innovations introduced into the hospital was to put bicycle bells on the wheelchairs, because the hospital gets extremely busy, but people had a habit of pushing patients around in a similar manner to which they drive. At least this way they could give a warning:

Check out the handles, I’m not kidding.

Which brings me back to the topic of driving and why our auto driver was a complete dick:
We had arranged for our driver to pick me up at 2:30pm to bring me back to our resort. There was one minor problem: On Monday, Anna wasn’t in India, she was returning from a weekend in Singapore, attending a wedding. Dr. Jap, Anna’s colleague and partner in the training, decided to attend a cataract camp that required her to stay in the hospital accommodation from Friday night to Monday. There had been a prior arrangement made for the driver to pick them up and bring them back to our resort for a round trip fee of ₹300 (approx. US$4.70) per day. He wasn’t informed that there was nobody traveling to the hospital from our resort on Monday so he waited out the front for two hours that morning. There was no communication error, Anna and Dr. Jap just forgot to tell him, admitted their wrongdoing and offered him ₹100 (approx. US$1.60) in compensation, to which he happily agreed and would accept from me, as well as payment for Tuesday upon picking me up from the hospital, a grand total of ₹400 (approx. US$6.30).

For those, who doubt me, proof that I entered a hospital while perfectly healthy or to pass something to Anna

For those who doubt me, proof that I entered a hospital while perfectly healthy and not just to pass something to Anna. To my right is a lotus, the symbol of the hospital.

When 2:30 came I was more than ready to go home. Waiting for this auto was probably the only situation I can think of where I was 20 minutes early for something! The driver pulled up, I got in the back, went to pass him his money and he asked, “Is madam coming?”. I explained that she was working and it was just me that was going back. He kept asking and I kept giving the same answer, then he asked me about later tonight. I told him I wasn’t sure and he refused to take me anywhere until I had confirmation that Anna and Dr. Jap would require his services.

He asked me to call Anna so I humoured him, knowing full well that she had just gone into the operating theatre and that there was no way possible she would be able to answer her phone. When there was no reply, I offered to text her his details and she could contact him as soon as she was able to, as she had purchased a local sim card and there would be no problems. He gave me his phone number, I messaged it to Anna, but then he came to the conclusion that Anna didn’t have a local number and I’d just shown him one to shut him up. He still refused to take me anywhere until he had confirmation of Anna and Dr. Jap’s plans, but he wasn’t going to let me go either, because I owed him money.
Instead, he insisted I speak to Anna. I told him again that she was working. He just shook his head and told me to do it, so again just to humour him I walked all the way up to the wet lab, asked the nurse to get Anna to call him when she was done and then I came back down. This was still deemed insufficient.

His next plan; write his name and phone number on a piece of paper and give it to the hospital security guard to pass to her, but the guard simply refused. He then tried to give it to the woman at the hospital information counter. I don’t speak Tamil, but just by her expression I could tell her response was something to the extent of “I have to speak to a trillion people a day who need medical help, do you really think I have time to organise taxi customers for you, too?”. Time to bring out the big guns. He insisted on speaking to Anna himself. Again, I tried to explain to him that she was operating on a patient. He just said “No, walk” and marched behind me gestapo-style until I had brought him as far as I could go. I got the nurse from the wet lab to speak to him, they went back and forth for a bit, then he nodded, looked at me and said, “Okay. Let’s go.” Some people will go to amazing lengths for a couple of bucks.

By the time he had agreed to take me back to the resort it was 3:00pm. School had just been let out (remember I mentioned that earlier, too?) and there were cars, bikes, autos, trucks, and children EVERYWHERE! I am absolutely amazed that I didn’t see a single casualty, be it pedestrian, driver, rider, or passenger, as they walk, ride and drive with absolutely no regard for human life. We eventually made it back to the resort and the driver insisted on speaking to Anne, the really cool owner of the place. She just started screaming at him and essentially told him to never come near the place again. Later she said to me that she had “just had a bad day and wasn’t in the mood for dealing with him.”

So, in closing, I’d like to thank everyone at the Aravind Eye Hospital for their hospitality and for making the experience as comfortable as possible and I would encourage all ophthalmologists to take the chance to come over here, not just to train at their excellent facilities, but also to enjoy the lifestyle that Pondicherry has to offer. Don’t base your entire opinion on one bad driver.

Anna and Dr. Jap with their local instructor in the hospital's wet lab, where they practise on they eyes from cadavers, as opposed to pig's eyes. Unfortunately, I took this photo as the instructor was putting his hands behind his back, giving him the appearance of 'The Rocketeer'. 

Anna and Dr. Jap with their local instructor, Dr. Indeevar V. Mishra, in the hospital’s wet lab, where they practice on eyes from cadavers, as opposed to pig’s eyes. Unfortunately, I took this photo as the instructor was putting his hands behind his back, giving him the appearance of ‘The Rocketeer’ taking off.

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