8/19/2018 0 Comments Hearing from the expertsWell another week has flown by here in Madurai! From last week's observations in the operating rooms and clinics, we extracted clinical needs using a technique called mind mapping -- one of the primary needs finding skills we have learned during our summer in CBID. These clinical needs can come from all areas of patient care, from diagnosis to surgical treatment to patient follow up. But before we select an area of innovation to build our yearlong project on, we must truly validate the importance of the needs we identified and come to understand what would make a meaningful solution to address each one. That's what we did this week.
To do this, our team spoke to key stakeholders in each of the individual departments (cataract, glaucoma and retina) to understand their perspectives on each clinical need. These stakeholders included nurses and trainees, as well as junior and senior level surgeons. Speaking to people in various positions and levels of expertise gave us a holistic understanding of the needs at Aravind through the unique insights each group had to offer. And across the board, our interviews were filled with genuine passion from these devoted eyecare professionals, making us even more motivated to deliver a useful and impactful solution. Ultimately, the deeply engaging conversations we had with these medical experts will enable us to prioritize the most important points of innovation and develop a meaningful solution over the course of our CBID experience. As we move into our final week at Aravind, we're excited to take the insights gained from these interviews, collaborate with our stakeholders to answer any lingering questions, and synthesize our findings as a team before we return home to Baltimore. - Nick Early Sunday morning, we set out on a hiking expedition, organized by our AuroLab friends, Hari and Gautham. Our first hiking point was the Samanar Malai, in the Keezh Kuyil Kudi village, located approximately 15m from Madurai. Samanar Malai directly translates to Jain Hill. The Jain Hill, as the name suggests, is named with respect to the Jain monks who once meditated and resided on the hills more than 2500 years ago. The hill officially protected by the Indian government as an archaeological site. The hill, as shown, stands next to a temple for Karupanasami, a village god, and has multiple Hindu sculptures and stone beds. To add to the majestic image depicted to us as we got down the van, there was a large pond showered with lotus flowers. As we hiked up the hill, first on a set of stairs and then on unchiseled rocks, we passed by more stone carvations depicting the ancient roots of Jainism in Tamil Nadu. The final view at the top of the hill was incredible --- we could see the entirety of the landscape, including the Meenakshi Amman Temple. The pinnacle was also the ideal spot to capture some scenic photographs. To the side of the temple is one of the Jain caves at this location, known as Settipodavu. The entrance to the cave contains a large carving of Mahavira, the last tirthankara (savior or spiritual teacher) of the Jain religion. As we left the Samanar Malai, I pondered over the the sequence of historical events and intermix between different cultures and religions in Tamil Nadu, which undoubtedly shape its present.
Our second hiking point was the Alagar Kovil Malai, located 21 miles away from Madurai. At the top of the hill is the Alagar temple. We did not go all the way up to the temple, although the journey up was an adventure in itself. The hike is known for its temple, and also its monkeys. Monkeys ranging from baby monkeys all the way to seniors lined on either side of the road, waiting, watching, protecting their territory. Hari and Gautham warned us not to carry any belongings in our hands as the monkeys are sure to take them. Kunal, our mentor, had a water bottle in his hand. It was the only bottle out, in case we needed it while walking up. You can almost guess exactly what happened next. As we were walking up a narrow pathway, a monkey came up to the middle of the road and started pawing at the bottle that was in Kunal's hand. Eventually, the monkey got its way, and it swiftly ran away towards the trees to devour its prize. We had a feeling that it was not the first time the monkey pulled a feat like this. After a delicious lunch at Anjappar Chettinad restaurant back in Madurai, we treated ourselves to some ice cream at ibaco. Ibaco had plenty of flavors --- but what stood out to me was the range of flavors pertaining to Indian fruits such as black currant and chikoo. With our hearts content from the day's adventures, we headed back to inspiration in our gold and white van to prepare for final week at Aravind. Until next time, Namratha 8/15/2018 0 Comments Visiting meenakshi temple
8/15/2018 0 Comments Interview and ponderingsHeading on to the next phase of our trip here has been an enriching experience altogether. We lined up interviews with various doctors form various levels of experience to substantiate and validate the insights and needs and delve more into the solution criteria surrounding the areas of interest and priority that were coming out from the process thus far.
Interviews were as varied as the doctors were. Some shared case studies taking us through grave and dire situations faced by the patients and the surgeons while other times there were light hearted moments of our shared experiences at the hospital. The depth, expertise and conviction of the surgeons never failed to inspire in us the desire to deepen our conviction to serve a community overburdened and unrelieved due to situation and circumstance. As I write this we prepare for our next interview. Seeing poverty and the struggle that the patients face is gut wrenching. Clinics are packed daily and people come from distant places taking even 2 days by train to get here and being really expensive in relation to their wages for the month. Repeatedly we were told of cases where patients were unable to afford treatment if they required multiple visits or complications and had to face hard choices such as paying for a treatment that took most or all their monthly income or keeping the money to provide for their family. What would you have done? Such situations seem to be commonplace. This anecdote gives truth to one of the main reasons why I chose to take up this program. Coming from southeast Asia I witnessed first-hand the healthcare inequality in rural areas across south-east asia and its consequences. Healthcare inequality in todays world is profoundly irrational in the light of technology and expertise that could solve such issues. That said, this why we are here. As ambassadors of Johns Hopkins we arrived but leave as ambassadors for those unable to enable change and institute it. Joshua Our first full week in Madurai has reached its end. We spent this week in the Aravind Eye Hospital operation theaters observing some of the most experienced surgeons and nurses in ophthalmology treat hundreds of patients. Brittany and Josh spent time in the retina OT, Namratha and Dan visited the Cataract OTs and Nick and I camped out in the glaucoma OT. Getting a first hand experience of the efficiency, quality, and hospitality of Aravind was incredible and eye-opening. We've learned so much in each of the specialities, from the procedures and workflows to the patients and nurses that care for them. Our keen observations and copious questions will blossom into meaningful innovations we hope to bring back to Aravind soon. In between all of these fruitful experiences, we took a break and spent a little time relaxing and having fun. Despite the relentless heat, we were able to cool off and relieve some of our pressure with delicious ice cream at Ibaco. We even managed to order and try the region's most famous cuisine, Domino's Pizza. These experiences outside the hospital broadened our periphery on Madurai, really brought our team together, and will help our team mesh moving forward on our endeavor to reduce needless blindness. Until next time, Krithik 8/5/2018 0 Comments Bringing Care to the PatientThis morning we hopped in a van and held onto each other tightly as we flew down the roads of Madurai. Passing all the fruit stands and morning commuters on motorcycles, we quickly arrived at a town 20 minutes away from our hostel. In this particular town, Aravind hosts an eye camp once every month. The amazing thing about Aravind is that 50% of the care they give is free. The paying arm of the hospital helps to fund the free arm. All patients who come to the eye camp don’t have to pay a dime for the diagnosis and testing they receive. The camp was held inside a beautiful Hindu temple and we removed our shoes upon entry. Inside was a miniaturized patient flow pathway which began with registration and ended with specs dispensing or surgery consultation. As this was a cataract-focused eye camp, much of the surgery consults involved what was necessary for cataract surgery preparation the next day. Aravind hosts eye camps on Sunday so that patients can be transported back to the hospital that evening for surgery on Monday. All of the travel and stay is free to the patient. By removing these barriers to surgical care, Aravind has been able to successfully treat 7% of the town’s population. We also met some ophthalmology fellows at the camp who were there delivering care and took a photo with them. We were able to talk to them about their experiences at Aravind and other training sites. We hope to continue to talk with them throughout our time here to gain feedback on our clinical needs. -Brittany 7/30/2018 0 Comments A Glimpse of the Eye at WilmerThis week, we had the chance to get our look at eye surgeries at the Wilmer Eye Institute at Johns Hopkins Hospital, specifically in the specialties of cataract, retina, and glaucoma.
Mornings at the Wilmer OR are a unique experience. Patients are waiting outside in the lobby with their loved ones, some older, some younger, some with white eye patches waiting to experience their new and improved vision after surgery. We are so thankful to have the opportunity to see what happens behind the scenes! We've split ourselves into pairs for each specialty. Dan and I are focusing on cataract, Josh and Brittany on Retina, and Nick and Krithik on Glaucoma. Of course, we are all aware of what's going on with each others observations, but splitting into pairs will help us learn all of the intricacies surrounding the procedure, which is critical for us to make the most of the time we will spend at Aravind. Behind the scenes: As in any surgical procedure, the surgery is made possible by a team of providers including surgeons, anesthesiologists or nurse anesthetists, and scrub nurses. What is different about eye surgery is that the surgeon looks into a microscope to obtain a closer view of the eye while performing the hand maneuvers required. Talk about hand-eye-coordination! The outside observer (such as us), has a full view of the eye through a television screen, which is convenient, since we want to understand each and every detail of the surgery. Today is our last day of rotations at the Wilmer. While it was short, we had a great experience getting our first look at eye surgery. This is just the beginning. In 24 hours, we will be on our way to immerse ourselves into ophthalmology, at a place that is known for its efficiency and commitment to equitable eyecare. Goodbye for now and see you in Madurai! -Namratha |
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