saving vision globally Archives - Center for Academic Global Ophthalmology

Wills Eye Global “Throw Back Thursday” how far we have come

Zubair Ansari MD — Thu, 18 Jun 2020 14:33:57 +0000

Last year, Wills Eye Global had two fellows, Zubair Ansari MD and Suzette Luke MD, who served as our Academic Fellows from July through June 2019. Here is Zubair’s report from the field. He recalls the beauty and development of Hyderabad, where he was born and remained the home of his mother. He returns as a Wills Eye Global fellow with a mission to reduce preventable blindness. His report:

Hyderabad is a large city in the south-central part of India, which has always been familiar to me. I was born roughly 400 km from here in a small town along the Godavari river called Rajahmundry. Most of the family have since moved to Hyderabad, and as such, I have visited this city multiple times since I was a child. Every time I visit, I am humbled by the level of progress and development this city has experienced. Many now refer to it as “Cyberabad” thanks to the massive tech boom of the 2000s or the new high-speed rail that zips along with the city. But most importantly…..read more here, https://www.willseyeglobal.org/through-the-eyes-of-my-grandmother/ Please consider volunteering or making a small donation in support of Wills Eye Global here, https://www.willseye.org/center-academic-global-ophthalmology/donate-to-center-for-academic-global-ophthalmology/

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A Day in the Life at LV Prasad

John Anhalt MD — Tue, 06 Aug 2019 14:51:51 +0000

Mornings start at sunrise and already Hyderabadi life is in full-motion all around me. The walk across the street can be perilous at best as most of the day there’s no break in passing traffic. From my bedroom window, I can occasionally catch a glimpse of monkeys chasing each other across neighboring rooftops. The walk to work is short but offers a brief snapshot into local life as I pass market stalls, a queue of auto-rickshaws and a Hindu temple to Hanuman.

Once I enter LVPEI, I quickly join the steady rush of residents, fellows, optometrists en route to lecture on the 6th floor. Lecture hall doors lock at 6:59 AM. Every day (Monday-Saturday) there are a series of journal clubs, research presentations and Grand Rounds that are mandatory for all hospital clinical staff.

The environment is collegial and inclusive; everyone is expected to participate from senior consultants to ophthalmology and optometry students. A breakfast of Idly, sambar, dosas, or my favorite, poori, is always accompanied by a small cup of chai. Everyone eats together in the dining hall and, again, it’s a purposely collegial atmosphere with consultants, nurses, residents and janitorial staff sharing the same tables.The clinic day then begins. Patients, who often arrive overnight, start queuing at the registration counter and by 8 AM many of the waiting rooms are standing room only.

On the surface, it may appear a little chaotic but that is only because of the sheer magnitude of patients being seen. In reality, from registration to checkout, the clinics are a well-oiled machine. Lunch usually consists of more chai with potato samosa and brief tea time at 4 PM helps push along clinic well past sundown.

Similarly, OR schedules often run until 10 or 11 PM with nearly 200 surgeries performed daily. The day-to-day schedule is at times exhausting but nonetheless, the residents and fellows appear unfatigued and rarely complain. A testament to the dedication for academic and clinical rigor – this schedule is perhaps what has propelled the institution (only 32 years old) to a global forefront of research, clinical training and most importantly, patient care.

Update as of October 2019: Patients meet with registration counselor who will discuss payment options to delegate the tier of care. In short, all patients are seen by the same team of doctors and receive the same care whether paying or non-paying. The entire hospital system, however, is supported by patients who elect to pay for services. These payment tiers are range from paying essential “at-cost” for care to paying upwards of 3-5x as much for services. The “supporters” are offered faster clinic times and more customizable treatment options (ie. premium/multifocal IOLs, femto-assisted surgery etc…) but again, all patients regardless of payment status receive equitable care from the same treatment teams. This tiered system allows LVPEI to continue its work in South India in which 50% of the nearly one thousand patients seen daily are cared for free of charge.

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Dr. Anhalt joins our partners at LV Prasad Eye Institute in Hyderabad, India

John Anhalt MD — Mon, 05 Aug 2019 19:32:31 +0000

My first rotation as the incoming Academic Global Ophthalmology fellow is at the LV Prasad Eye Hospital in Hyderabad, India. Our program has been sending fellows there every year since our first fellow, Dr. Alessandra Intili, five years ago. We are fortunate to have maintained this great relationship since the four weeks that each fellow spends here is filled with extremely high-yield clinical and surgical training. During my time here, I will partake in a Manual Small Incision Cataract Surgery (MSICS) training program that will help prepare me for the year to come.

I arrived in India several days ago and immediately dived into the rigorous training schedule that is a hallmark of LVPEI. As primarily an observer for these first few days, I’m starting to take in the scale and significance that LVPEI has for eye care in the region.

As a little background,

Established only 32 years ago, the hospital system serves a population of over 50 million from the southern Indian states of Telangana, Odisha and Andhra Pradesh. The sheer magnitude and efficiency of the operations here are awe-inspiring. To meet the needs of the region, the hospital system a central “flagship” hospital in Hyderabad as well as three other massive tertiary campuses in surrounding regions. To access smaller cities and towns, there are 19 secondary sites, each with their vision screening programs, clinics, and operating rooms.

At these sites, fellows and residents each spend almost a year operating with complete independence: it is a core component in their training. Surgically, these sites perform cataract extraction and pterygium excision primarily, however, they always have the safety net of any of the four tertiary centers to refer complicated cases, complications or patients who require subspecialty management. Feeding into these secondary centers is an expansive network of 180 vision centers and “vision guardians” who are individuals from the community trained to recognize basic eye disease and visual deficits. This network serves to connect small towns and rural villages to the secondary centers. This pyramid of escalating care is a central part of how LVPEI can deliver such effective care to such a large patient population. Over the next few weeks, I am excited to learn more about how the LVPEI system works as well as gaining familiarity with the Aravind model when I travel to Madurai next month.

Tomorrow, I have been assigned my first MSICS cases of this fellowship. I will be operating under the mentorship of Dr. Swapna, and I look forward to challenges and rewards that lie ahead…

The featured photo is the main clinical wing; each floor is dedicated to one or two specialties.

These last two are the new wing for “sight savers” which is a higher payment tier that not only financially supports the hospital but allows for 50% of the patients to get treatment completely free of charge. The hospital had a full-time artist commissioned who made all of the art for the hospital. There are so many beautiful paintings around the hallways, and each clinic it would be impossible to capture them all. There are so many paintings around the hallways, and each clinic it would be impossible to capture them all. Also, I’ll see if I can get better external photos of the hospital, the lighting was odd when I tried this evening.

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Madurai: “The City of Temples”: Training at Aravind

Zubair Ansari MD — Wed, 24 Apr 2019 15:16:44 +0000

Born in the “City of Temples,” Madurai, India there is an eye hospital that serves as a model for healthcare delivery and inspiration to anyone in global medicine. That model is Aravind Eye Hospital. Established in 1976 by Dr. Govindappa Venkataswamy, Aravind was conceived as a facility to serve the needs of a small rural community in southern India. Over the years, however, the Aravind network has vastly expanded to serve the needs of not only Madurai but the entire world through multiple facets.

The first, through the creation of multiple tertiary, secondary, and primary centers aimed at reducing blindness through screening and referrals of communities throughout India.

Second, through the development of state-of-the-art laboratory that produces thousands of ophthalmic surgical products (such as intraocular lenses) at a vastly discounted price point compared to American or European prices, making surgical care affordable and accessible to everyone in the world.

Lastly, through education and leadership. Education to Aravind is not just relegated to its ophthalmology residents and fellows in India, but also available to any ophthalmic technician, optometrist, or ophthalmologist around the world. It also has a vast “sister” program that hires and trains women from nearby villages and communities to be surgical technicians, access care, and optometric technicians, empowering them with the necessary tools for any job in the real world when the opportunity may not have existed otherwise.

As a global ophthalmology fellow, Aravind was an exceptionally formative experience for me. The relationships I made here, and the experience of seeing this incredible model at work is one that I will cherish for the rest of my life. Pictured here are a few photos of my trip to Madurai, including a photo with Dr. Vel Balaji, a comprehensive and cataract specialist at Aravind who was an incredible host and friend to me. Also included is a picture of the Chief of Medical Education of Aravind Eye Hospital, Dr. N. Venkatesh Prajna, at his book release “Aravind FAQs in Ophthalmology” (A MUST read for any resident or fellow preparing for board examinations around the world).

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