Archive for October, 2008


Aravind – Pondicherry Trip

Oct 29, 2008 in Uncategorized

Pondy OTMore hiking and a weekend away… Two weekends ago Sushil, Ashwini, and I went for a hike on our Sunday off. Traveling about 20 km from Madurai yet another temple that is over 2000 years old. Alagarkoil is a temple to Vishnu that is located on a forested hillside. It seems the supply of ancient temples and hillsides is endless, and as usual, monkeys provided additional entertainment while we hiked.


A break from the noise and chaos of Madurai was in order, and as this Monday was Diwali, I thought it would be perfect timing to make a trip to a Tamil Nadu city with heritage from its French colonial days. Puducherry (a.k.a. Pondicherry). I took the overnight was an eight hour trip from Madurai to Pondicherry, made slightly less painful with the company of two English girls (Zoe and Amy) on the same trip. Little did I know, the idea of a sleeper coach is slightly deceptive. The road was bumpy and there were several times the driver laid on the horn and swerved suddenly. The Indians must be used to it, but none of the westerners sat at the back of the bus got any sleep!


Arriving in Pondicherry early Saturday morning, I briefly refreshed and went to the Aravind Hospital branch there. This is the newest addition to the Aravind system, built in 2003. There are 600 beds, the hospital is located on 20 acres of land and is 200,000 square feet of space. Renjith, the Manager of Outpatient Services, took me on a tour of the hospital. It is clear that much emphasis is placed on high-output and efficiency, a good reason why Aravind is a case study for the Harvard Business School. We went from step one, when the patient enters the hospital, through all the necessary screening, and on to the operating theaters of the largest specialty hospital in Asia.


I also got to meet with Dr. Venkatesh, who had kindly invited me to visit Aravind Pondy. We talked about what there is to see and do in Pondicherry and he asked if I would like one of the residents I met in the operating theater to show me around that evening. Of course I was happy to meet up with Sunny, who showed me around Pondicherry that evening and took me for dinner at a local French restaurant, Rendezvous. It was surely the best food that I’ve had in months. As a resident, he also had some interesting insights into the differences between American and Indian systems of training as well as a brilliant quote: “There are bumps in the road and bumps in life; here in India we are used to them, dealing with bumps comes naturally to us.”


The next day I got up early to meet the Britts for breakfast and a little tour of Pondicherry and a couple museums. There is not a lot to see in the main Pondicherry museum, but it is interesting to learn about all of the various cultural influences (i.e. Greek, Roman, French, etc.) that have touched this coastal city over the years. We also found out that most of Auroville would be open that day, but not during the Diwali celebration on Monday.


So I headed over to the “Universal City”, Auroville. It is an interesting enclave that is dedicated to unity and peace. The most interesting thing I found there was the Matrimander, a sphere with gold disks covering it, which is reminiscent of the Epcot center in Florida. You need to make an appointment to go inside, which Renjith from Aravind helped me out with, and it was definitely worth it. There is a spiral staircase around the lower half leading to the upper chamber. That room is for meditation, and is lighted with a beam of light focused on a huge crystal ball in the middle of the room. Interesting…


I spent my last day in Pondicherry exploring the town. The beach on the Bay of Bengal was beautiful, but you can’t swim on the main beach because of the rocks. However, the Auroville beach is nice and saw plenty of people enjoying the water there.. I also went over to the Sri Aurobindo Ashram, Gandhi Statue on the beach, and the School for Perfect Eyesight. Besides the constant bombardment of fire crackers for Diwali, many of which are more like bombs than the blackcats that I remember back home, it was a nice, relaxing weekend.

Cataract Surgery and Sightseeing around Madurai

Oct 17, 2008 in Uncategorized

Dr. VRMWith the monsoon season (September – November) in full swing, this last week has been a little more relaxed and slow paced than the previous ones. Thanks to a package from mom, I was able to make pancakes with home made raspberry jam for my friends Verma and Ashwini for brunch on Sunday morning. Later in the day we took our new friend Ankoor (the MEEI resident I met last week) sight seeing to Thirumalai Nayak Palace. The building was amazing, especially the pillars (58 feet tall and 5 feet in diameter). See the picture below for some perspective!


Most of the palace is under reconstruction and really not much to look at, but there is also an adjacent museum with lots of cool sculptures and other ancient ancient artifacts. Outside we decided to take a walk around the palace grounds, where we found a group of children who for some reason were thrilled to see me, maybe they thought I was famous. Anyway, it made for some good laughs and you can see the picture below too!


Early this Wednesday morning I saw Dr. Prajna do six cataract surgeries and a pterygium removal with conjunctiva transplant. All the surgeries were different, in one case I observed a Manual Small Incision Cataract Surgery, which is done without the use of the expensive phacoemulsification machine. Dr. Prajna dexterously removed the lens and replaced it with a solid implant within 10 minutes! After the surgery was over, he told me that it is really the great results that bring patients to Aravind. Former president Dr. APJ Abdul Kalam comes here for his care, and at least one patient that I saw that day had come from Chennai (8 hours by train) to have his operation at Aravind. Another bonus of getting up early was that the chief of cornea surgery invited me to stop by anytime to see some LASIK or cornea transplantation surgeries, which I will definitely take him up on.


This week was also Dr. VRM’s birthday, so the evening before we went on a little shopping trip to buy him a cake and gift. I thought I was just there for moral support, but ended up deciding on the birthday cake and coming up with a design for it! We also made a trip to Pudumandabam market where there are hundreds of shops covered by a high stone ceiling. It is right across the road from the Meenakshi temple (and considered part of the complex which dates back to 600 BC). You must haggle here, and one of the shop attendants informed me that she frankly doubles the price for any foreigner. That’s not a surprise, but definitely helps to have Tamil friends!


At the birthday party Dr. VRM cut the cake and looked around for the oldest person in the room, that person receives the first slice. That’s a new tradition for me, but singing the old “happy birthday” tune was the same here as everywhere else. As were the people, won’t say who, sneaking frosting from the plate afterwards!

Tirupparankundram Hike and Sarasvathi Puja

Oct 12, 2008 in Uncategorized

Enjoying the viewIt has been another inspiring week at Aravind. Dr. VRM was in the Hindu Times recently. He also asked me to present my work and project proposal in our weekly lab meeting. I always feel a little anxious talking about my work to a large group, but it went off quite well, and I our discussion afterwards was helpful in making concrete decisions about my next steps to move the project forward. Now I need to start some delicate RNA isolation work.


One of the interesting events of the week was the celebration of the goddess Sarasvathi. She is the goddess of education. In the hospital there were several pujas, where items such as pipettes and books (in our lab) were given blessings. In the outside corridor of the operation theater, the microscopes and phacoemulsificationequipment was blessed. These ceremonies involve some prayers with burning of incense and finally a treat passed around. They also pass around some chalk dust in different colors (which I don’t know the meaning of yet) that is to be placed in a dot above the forehead. My understanding of the purpose of this is that it is to cover your third eye or chakra emanating from the forehead to minimize distraction.


For the Seriasvathi celebration there was also a special event in the hostel. It is the one time each year where girls are allowed to enter the boys hostel for dancing. There was another American at this event, a fourth year ophthalmology resident from Massachusetts Eye and Ear Infirmary who is at Aravind for an elective rotation from the Harvard program. Some of my lab mates were also there, and we joined in the fun. It reminded me of a middle school dance, where the guys are wallflowers while the girls dance, but eventually everyone got into it and we had a nice time.


Four of us from the lab spent our Saturday afternoon hiking up Tirupparankundram (just try pronouncing that!). It is a giant rock outside the city that reminds me of the pictures I have seen of Ayers rock in Australia. There are some proper steps up the hill, but many of the steps are divots carved into the rock face itself. Along the way we spotted dozens of monkeys. They don’t seem to be intimidated by humans at all, as they will come close enough to touch, and my friends advised me to keep a tight grip on my belongings as they are known to snatch things, especially food, from people.


The best part of the trip was the truly spectacular view from the top. We could see all of the city of Madurai and the surrounding mountains, rock formations, rice paddies, and coconut trees. The closest comparison to areas I have been in the united states is the rock formations of the southwest, or maybe the red rocks in Denver. I’ll post some pictures, but as I noticed while I was taking them, it is really impossible to capture the beauty of a place like this in photographs.


As we reached the top the weather took a turn for the worse and it started pouring down rain. Fortunately, we found an Islamic holy place at the top for shelter. The men and women were dressed in burkas and white caps, which is otherwise rarely seen in Madurai. One of the temple priests told us that a pious Muslim is said to have stopped a massive rock from falling in this place and it has remained there since that time. They didn’t let the others from my group go into the sacred area of the temple, but for some reason they let me in to see the rock and the men praying inside the grotto. After about an hour the rain let up and we went on our journey home.

Dedication of Dr V’s Eye Research Institute

Oct 05, 2008 in Uncategorized

New Research BuildingWow, this week was especially packed with interesting events!

First of all, I started getting some clinical experience… Dr. Kim offered to let me work with one of the fellows in the Retina Clinic, who showed me how to examine patients with the indirect ophthalmoscope and slit lamp. For those who don’t know, indirect ophthalmoscope looks similar to a miner’s head-lamp with lenses on the headpiece and a separate hand held lens that is placed near the patient’s eye. With one hand you hold the lens and the other you hold the patient’s eyelids open. It isn’t easy, and I only caught a quickly vanishing glimpse of the retina on the third patient I examined! I was reassured by the fellow, who said that there is a steep learning curve with this instrument.


Early the next morning I observed my first surgical operations at the operating theater (what we call the operating room, OR back home) in Aravind. I watched two vitrectomies with pan photocoagulation for proliferative hemorrhagic diabetic retinopathy, and one scleral buckle procedure for retinal detachment. For those wondering what you can actually see while observing eye surgery, you see what the surgeon sees. Everything is done under a microscope with video to a TV mounted on the OT wall, but the best view is from the second set of oculars attached to the surgical microscope. It’s awesome to see what the surgeon is sees!


What was probably the most exciting and interesting event of the week was the inauguration of the new research building. The night before the big event, we had dinner and took in a cultural program that included traditional South Indian dancing (Barathanatiyam). See the pictures below. The dinner was held at the Aurolab, about fifteen minutes drive from Aravind, and was also attended by about one dozen guests of honor from the United States(mostly ophthalmologists who have worked with Aravind over the years). The traditional Indian dance was impressive, and the food was great too! Sorry foreigners, no utensils!


The next day was the inauguration ceremony, which was attended by former President of India, Dr. APJ Abdul Kalam. Dr. VRM (my mentor) introduced me to him personally; I shook his hand and got his autograph on “Wings of Fire,” his autobiography! The man is very popular in India and known as the Missile Man for his work (as a physicist) to develop the Indian rocketry program which frequently makes news. I also noticed that he rides in a Ford with a V.V.I.P. sticker on the windshield. Take a look at my photos from that day, we group picture with him and everyone from the lab!


One auspicious day a few weeks ago we had the puja (blessings) for the new building. Similar to the wedding puja, there was a lot of smoke and chanting involved, and I won’t pretend to understand what was going on. I’ll just post the pictures and let you see for yourself (see below). We also had an opportunity to tour the new, and still unfinished, lab at that time. It sounds like we’ll actually move in sometime in December or January. Anyway, I think that the puja was more authentic than the ceremony this week, which seemed to be mainly for the media.


This weekend there was more excitement as I traveled to Erode with a friend from lab (Ashwini) to her family’s home. Her father is a Dermatologist who offered to show me the leprosy hospital that he operates. There were 31 patients currently undergoing treatment at the hospital. He took me through the wards describing the different findings in the various forms of leprosy and showing me examples. I also observed the biopsy procedure and how to identify the bacteria (Mycobacterium Leprae) that causes Hansen’s disease under a microscope from the tissue taken from an infected patient.


This weekend I also went to an ancient temple on a mountaintop to get a close up view of wild monkeys. We at left at 6:30am Sunday morning  to see the monkeys before they retreated to the forest. With Dr. Shankar we rode in the Sumo SUV for about an hour on windy, and bumpy, Indian back road with rice paddies and coconut trees on either side. There were less monkeys around than usual, but we saw a dozen or so and fed the remaining bananas to the cows!


While in Erode we also went on little a shopping trip, and I purchased a dhoti and kurtha, traditional Indian garb. I also got a lesson in languages. While traveling the back country roads near Erode, Ashwini taught me some new Tamil phrases… when I tried to ask the driver “how are you?” in Tamil, I got a confused look from him and laughs from the back seat… apparently she had actually been training me to say “give me 100 bucks!” Hahaha.