Friday, February 20, 2009

Day Three – Free Hospital and Vision Center, Madurai

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Apologies for the delay in posts as the internet connection here in India can, at times, be scarce. But back to the study tour…

Known as the Temple Town, Madurai boasts a series of 13 temples from different periods in Tamil Nadu history, and is the most famous of all temple areas in southern India.

Vision Center
We began our day with a short drive out of the city to the village of Alanganalure, which is known for its Bull Taming festival and the fierceness of the women from this region. Our focus was seemingly a bit more mundane, however, as we went to visit one of Aravind’s 37 vision centers in South India. Each of these centers is connected to one of five base hospitals. This one, for example, is connected to the one we visited in Madurai yesterday. Through a program with the U.C. Berkeley and Intel, they have a fixed point broadband system – with the vision centers at one end, and the base hospital at the other.

It was amazing to see this system in action. A doctor at the base hospital works with anywhere from five to 12 vision centers. The patient form the local village comes in to the vision center for a scheduled appointment, surgical follow-up or other eye issue. The vision center is staffed by two of the sisters – one who is responsible for the registration, patient flow and refractory products, and another who carries out the eye examination. Many of the same ophthalmologic tools in the hospital are in this facility – really an old shop-front about 10 feet wide and 30 feet deep. She will perform the routine tests of blood pressue, eye pressure, blood sugar, refraction, and fundus imaging, etc., right here, then connect with the doctor at the base hospital. This telemedicine technique is revolutionary as people unable to make the journey to the city can still talk “face-to-face” with the doctor, who has just received the test result for the patient electronically. The consultation takes place directly, and any medicines or corrective eye wear can be obtained immediately at the facility. Any surgical recommendations can be acted on as soon as the patient is ready to go to the hospital. The sisters are from the village, so have a good relationship with the patients, resulting in an experience that may be less intimidating than a hospital visit.

Besides the two sisters at the vision center, there are two field workers who are responsible for seeing one-half of the covered population (about 50,000) each year. Their task is to visit each house, and screen the vision of the inhabitants. They also encourage older residents to come in for annual glaucoma exam to decrease the effect of this disease. Because the loss of peripheral vision is so slow, a person with glaucoma may have no idea that their vision is decreasing until it is too late.

Free Hospital
After lunch, we set out for the Free Hospital at Aravind. Other Aravind hospitals around Tamil Nadu were built with free on one side, and paying on the other, and the surgery and specialty areas in between. Aravind Madurai started as an 11-bed hospital, and has grown in fits and spurts, adding space as needed. Because of that, the Free Hospital is on a separate campus, around the block from the Paying Hospital. Unlike in U.S. where free care only follows massive amounts of qualifying paperwork, the patients at Aravind select the hospital in which they are seen. There is a perception that if it costs more, it must be better, and that drives many families to sell a cow or take out a loan to afford treatment at the Paying side. Aravind does nothing to dispel this myth, as it keeps people more honest about their ability to pay. The interesting thing is that the care at Aravind hospitals do not differ at all, with the staff cycling though both hospitals during the week. The main difference is the accommodations. Instead of a private suite with one’s own bathroom, the Free Hospital offers mats on the floor or cots. This concept of choice also extends to the type of intraocular lens the patient selects.

A Little Sightseeing – Meenakshi Temple
After a reluctant goodbye to the Aravind staff, we headed back downtown to the Meenakshi Temple, tallest of the 13 in the city. We were hosted by two of the city’s leading authorities, and spent the afternoon exploring the beautiful stone interiors dating back thousands of years. This temple was built to honor Meenakshi, one of the forms of Shiva’s consort. She is Vishnu’s sister, and symbolizes the peaceful coexistence of the two lines of followers of Shiva and Vishnu. Some people believe it is why there is comparatively little religious conflict in the area. The story is that Shiva rode into town on his bull, and married the feisty goddess, making her submit (eyes down, etc.) before the marriage. When they were officially joined, the tables turned, and he submitted to her. On the occasion of the marriage, the streets flowed with milk and honey. We saw the Temple elephant being walked for his health, and the “People Tree” where women hang cradles in amongst the leaves and pray to have children.

All packed up, but sad to be leaving this land of milk and honey and the birthplace of Aravind. Tomorrow, we fly back to Chennai, and drive south from there to Pondicherry (Puducherry), an old French colony by the sea.

Dreaming of Madurai,

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