I came to Aravind in response to two callings. One was to perform charity eye surgery, the
other was to learn the surgical craft of MSICS (Manual Small Incision
sutureless Cataract Surgery) from Dr. Venkatesh. During my Ophthalmology residency of 1991 to
1994, I performed cataract surgery initially with ECCE (Extra Capsular Cataract Extraction) using large incisions that required suturing, but as
phacoemulsification technology was introduced, I completed my residency
performing phacoemulsification on all cataract cases. Thus I have been a “phaco” surgeon since
about 1993. Twenty years later in 2013,
I’m learning MSICS. The natural progression
of training at Aravind is for surgeons to learn ECCE, then MSICS, then
phacoemulsification. According to Dr.
Venkatesh, I may be the first phaco surgeon who chose to learn MSICS, after being
a phaco surgeon for the majority of my career.
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| Author performing MSICS, with sister Muthumari as assistant. Sister Mageshwari in the background preparing for the next surgical case for author. |
Aravind Eye Care System has been training ophthalmologists
from around the world since the 1993, under the auspices of Dr. Natchiar. During my one-month stay at Aravind
Pondicherry, I saw one ophthalmologist from China (Dr. Lulu Chiu), and another
from Maldives, receiving training. The
training is centrally coordinated by Aravind Madurai, and locally coordinated
by each hospital’s administrator, Operating Theater supervisory sister and
training program sister. At Aravind
Pondicherry, it was Poonguzhali and Vimala.
Other than me, all trainees would follow a program of textbook, videos and
wetlab coordinated by Vimala, accompanied by observing surgeries in the
Operating Theaters and eventually supervised performance of surgery,
coordinated by Poonguzhali.
 |
| Dr. LuLu Chiu being supervised by Dr. Swati |
In the case of Dr. Chiu from China, she has been
working in a Chinese hospital for years merely as an assistant, and chose to
come to Aravind Pondicherry to obtain hands-on experience, therefore this was
an ideal environment for her to progress from wetlab, to observing surgeries,
and eventually to supervised surgery.
When an operating table, microscope, and team of
sisters is assigned to assist a trainee ophthalmologist, the remaining tables
in that Operating Theater would be used by more experienced surgeon, to be in
the same room as the trainee surgeon, to back up the trainee in case of
intraoperative issues. Under this
circumstance, the other non-trainee Operating Theaters would have to take up
the slack and clear the surgical backlog for the day. For that reason, trainee ophthalmologists
usually observe surgeries on Mondays, and perform surgery under supervision on
other days (including Saturdays). Since
surgery generally conclude by early or mid afternoon, trainees continue their
self-directed education at the onsite ophthalmology library where there are
computer stations with surgical videos, texts, and current ophthalmology
journals, attend rounds with the residents, or continue to practice in the
wetlabs. The wetlab is unique, because
not only goat but also human eyes are used for training. In North America, teaching institutions
purchase pig eyes from companies specializing in animal tissue, usually at a
cost of $5 USD per eye. In Tamil Nadu,
the state where Aravind Eye Care System is located, the Tamil South Asians willingly donate their organs for medical training and
research. At all times, an ophthalmology
resident is on call to harvest eyes for the Aravind Eye Bank. In North America, individuals sign an
organ-donation consent while alive consenting to donate part or all of their
body for medical research upon death. As
I understand, in Tamil Nadu, if the deceased has no such written consent, their
next of kin can consent on behalf of the deceased. Dr. Anupreeti explained, the donor or the
next of kin donate the eye for medicine, not for any financial compensation but
because it is good to give to the world.
Trainee ophthalmologists at Aravind are fortunate to learn on human
cadaver eyes rather than porcine eyes, because of this generosity. The donation of eyes also means Aravind has
more access to donor tissue – especially cornea – for vision-saving surgery
like corneal transplant surgery. The giving by the donors,
perpetuates education, and perpetuates sight for the living.
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