This whole experience still feels surreal and it’s my
last evening to relax before I start my rotation at the hospital in the
morning. I’ve been asked to arrive promptly at the reception desk for 9am,
which seems like a let off as I’ll be expected to start at 7am for the rest of
my time here, working 6-days a week. I fear I’m going to struggle to sleep as I’m
still considerably jet-lagged and waking up late today didn’t help solve this
issue in any sort of way. I think it’s going to be a continuous cycle of poor
sleeps, followed by hectic days, which will eventually lead to me craving my
bed and resetting my sleeping pattern to one that is time-zone appropriate.
As the hospital is closed on Sundays, it’s been strangely
quiet today. The grounds are fairly empty, and I’ve only come across a few
security guards and reception staff on site, which is a dramatic contrast to
the initial craziness I was exposed to yesterday upon my arrival. Though, I’m
sure I can expect an influx of crowds and for the hospital to return to its
usual busy self when the gates open in the morning. I decided to visit the
on-site canteen today at LVPEI – which operate on a strict vegetarian policy,
including no eggs. I did pass this cafeteria yesterday, however was put off by
the large queue that seemed to snake around the room and continue around the
outside of the building. Today however, it was occupied by only 3 other
individuals who were indulging in their meal. I was incredibly shocked at the
low-prices, with my meal consisting of 3 separate side dishes and a large plate
of rice coming to a grand total of 50 rupees (equivalent of about 60p). I opted
for a 1L bottle of water to accompany my meal and help restore adequate levels
of hydration is this heat, pleasantly surprised again as this only cost 20
rupees (about 25p). It’s crazy to think that this same portion of vegetarian
food from any Indian restaurant back home would probably cost around or in
excess of £10.
I’ve had a lot of time to myself over these past 2 days,
which is something I’m not actually too used to as I’m pretty much always with
my friends or family, unless I’m at work or asleep. I’ve had some time to read
a little more about the hospital and adjust to the noisy surroundings, and I’d
like to share some of my expectations and reservations of what’s to come
throughout the duration of my time here at LVPEI.
I was warned by a number of individuals prior to my visit
that the working life in India is a lot different to that in the UK, some
describing those who work in the healthcare sector here as having a rather
‘militant’ attitude. This belief is supported by a strict set of rules I have
received that I must obey at all times during my stay here. The list is pretty
exhaustive; I’ll provide you with a short insight of some things that stood
out. Firstly, the working day at the institute begins at 7:00am and all members
of staff are expected to report by 6.58am, with their being no tolerable
excuses for late arrivals. I guess it’s pretty handy that my accommodation is
within the hospital, and a quick commute downstairs is all that is required –
it makes the early starts less daunting than if I had to travel from elsewhere.
All of those who are present for work are not permitted to leave the hospital
site until the last patient checks-out, and although this is provisionally
pencilled in to be 5pm each day – it is actually rarely the case. As
we’re unable to leave the premises, we are required to bring both breakfast and
lunch or eat at the on-site cafeteria. Typically, Sundays are regarded as holidays,
but I may be required to attend post-op consultations if needed.
As discussed previously the hospital maintains a strict
vegetarian only policy, with no meat or eggs to be consumed anywhere on site. I
guess this means I’ll have to travel the streets of Hyderabad in my quest to
find the best chicken biryani, but don’t worry I’ll keep you posted on my
journey. Smoking and alcohol consumption are both prohibited at the premises,
which is in line with my expectations. Surprisingly there were no Dr’s or staff
having a cheeky cigarette and a redbull just outside the gates, which is a
common site at most UK based hospitals. I’m expected to refrain from using
lifts at all times, unless I have medical grounds to do so, and must instead
use the stairs. Funnily enough every lift has a sign on it that says, ‘Burn
calories, take the stairs.’ In addition to this, I can only use the staff
exit/entry pathways throughout the hospital and must not confuse this with the
patient’s walkways.
In terms of the dress-code here at LVPEI, I must wear a
‘pleasant coloured’ shirt, tie and formal trousers. This must be accompanied by
a plain white and ironed lab coat, and I’m expected to wear these at all times
throughout the working day, whilst having my guest badge in clear view for all
security to see. I’ll admit I love wearing smart clothes in a professional
setting, as it makes me feel like a fully qualified optometrist rather than a
confused university student and would normally never have any reservations
towards this – except for the fact that I’ll be working in 30º of humidity and
heat. I feel like I’m sweating just thinking about it, who knows how I’ll
manage when I’m dressed in the morning and ready to go with layers upon layers.
I’ll have to use abnormal amounts of antiperspirant as if I’m back at school in
the P.E. changing rooms, and hope for the best from there onwards; until the
day ends and I can jump back in the shower!
The final rule I’d like to bring to your attention is that
all male members of staff must be clean shaven. Yes, yep, you read it right. I was confused too, i thought a lot of Indian men normally sport quite girthy moustaches - but here, that wasn't going to be acceptable. Now, it’s not like I’ve ever really grown an impressive beard by any stretch of my
imagination, but I definitely don’t remember the last time I clean-shaved. It
was probably back when I was in 6th form, and that’s only because my
elder cousins used to take the mick out of my beard that never connected and
refer to my side burns as having a lamb chop-like appearance. I must mention
though; my Mum was delighted that I’d be clean shaven and baby-faced once
again. However, I feel like when I look at myself in the mirror, I resemble a
younger version of myself from the pre-pubescent phase of my life. Also, in
other news, where did these cheeks come from? Gym is definitely going to have
to be joined in January (new year, new me), I should never have fallen off that
bandwagon and now that I’ve said this on here for you all to read, I have to
get back in there. So anyway, back to shaving, I’m glad to say I only cut
myself a total of twice – so can conclude that I made it out ok, compared to
the massacre I was expecting when holding a blade against my skin for the first
time in years.
In terms of my actual placement rotation, I will be spending
time in a number of different departments and experience a wide variety of
specialisms. These vary from more simple areas such as routine eye check-up’s
and post-op consultations, to working in departments focused on cancers of the eye, being able to watch live surgeries and
participate in labs involved with ocular prosthetics. The only fake eye I’ve
seen before was a stress ball that I was given at University during revision
period, so I think I’m going to be in for a little surprise here. I am so eager
to try and experience as many different areas of the hospital as I can
throughout my stay here, also keen to try and venture out to the primary and
secondary care centres within the community and see how the practice differs
there compared to the tertiary care at the hospital. I want to get hands on
with the clinical aspects of optometry, and hope to see a number of different
pathologies, especially any rare cases that I may not come across in more
developed countries with larger healthcare infrastructures such as the UK. In
addition to this, i think i noticed that there is an Indian Optometry School that occupies a small
portion of one of the floors in the hospital (or at least has some involvement here), and I would love to see how the
teaching and course structure here differs from that in England.
I’ve continually said I’ll provide a little more information
on LV Prasad Eye Institute (LV doesn’t stand for Louis Vuitton), so here are
some facts about the hospital;
·
LVPEI was established in 1987, in Hyderabad by
Gullapalli Nageswara Rao
·
The eyecare institution operates as a non-profit
and non-government funded organisation – actually rejecting government funds as
this usually results in the Indian government trying to gain control of the
facilities and premises
·
The mission of LVPEI is to provide ‘Equitable
and efficient eyecare to all sections of society’ - with an emphasis on those with low incomes who are often under-served
·
A veteran Indian film-maker (LV Prasad) who was
aware of the rapidly increasing rates of ocular-related issues in India donated
a total of 10million rupees and 5 acres of land in Banjara Hills, which helped
establish this eye institute and centre of excellence
·
So far, LVPEI has served over 24million people,
and over 50% of these cases have been completely free of charge, irrespective
of the complexity of care required
·
Although the main centre of the LVPEI network is
in Banjara Hills, there are 3 other tertiary care centres, 18 secondary care
centres and 176 primary care centres that operate within India
·
Amazingly LVPEI has managed to set up a bank of
cornea’s readily available for transplant to all patients who require this
treatment, abolishing long waiting times for a cornea to become available – all
those who require it will undergo an operation within 24 hours of presenting at
the hospital
·
LVPEI also contributes significantly to
promoting good eye health within the community, trying to work towards
prevention of such serious eye disease that can be avoided by taking necessary
precautions. Some patients of LVPEI who commit to these courses are actually
rehired by the institute and placed in one of their community centre local to
the individual’s home, therefore allowing the individual to work and earn a
living to support their family
LVPEI operates on a pyramid
scheme which I have provided some detail on below;
·
Vision Guardians (Base of Pyramid) – This
represents community involvement. Vision guardians comprise trained young
individuals, who essentially screen the eye health of about 5,000 people within
communities, through door-to-door surveys and other informal means
·
Vision Centres – This is the next level and
provides primary eye health needs to that of the local community. These
centre’s draw upon local talent and provides jobs for these individuals who are
willing to learn and work. Each vision centre cares to around 50,000 people
amongst a cluster of villages
·
Secondary Eye Care Centres – These network
closely with the vision centres, and each serves a population of 500,000
persons. These centres provide slightly more intricate care, and can diagnose a
complete range of ophthalmological disease – offering high quality surgical
care for routine conditions such as cataracts – the most common cause of
blindness. These centres also draw on local talent in the community, who are sent
to LVPEI’s tertiary centres for training
·
Tertiary Care Hospitals/Training Centres –
Linked to secondary centres and each serves a population of around 5million
persons – these centres provide a comprehensive range of complex care, and also
train individuals to work within the community centres at lower levels of the
pyramid
·
Centre of Excellence (Top of the Pyramid) – Linked to tertiary
centres and serves a population of 50million persons. This treats the most
complex of the diseases, and individuals who cannot receive adequate care at
secondary or tertiary centres can be referred here
The LVPEI model aims to provide affordable or free eye care,
without compromising on quality of treatment or quality of vision. Vision
centres in the community are expected to eliminate around 75% of all avoidable
blindness, thus only 25% of visually impaired individuals in rural and remote
areas need to travel to the more major cities for tertiary or more specialised
care.
Personally, I would say one of the most fascinating things
about the hospital is that they are completely financially independent of the
government and use a unique scheme to allow this. I’ve previously mentioned a
little on this in the first blog, but LVPEI essentially guarantee treatment
free of charge for those who cannot fund it. This is made possible by the
fact that those who can afford it and require complex operations pay slightly
more than the normal rate, and as a result receive care from some of the top
specialists around. This funding then trickles down the entirety of the
hospitals departments and allows for other treatments to be paid for. LVPEI also
receives a number of donations, these can be from individuals or from larger
corporations who support the work that is carried out at this centre of
excellence and its extensive network in the community. As mentioned before
also, LVPEI have been asked to adopt a similar model in the country of Liberia
where they will aim to improve the poor rates of vision and ocular health of
the country.
I’m extremely excited to start my placement in the morning
and looking forward to the opportunities that arise and the stories I’ll be
able to share with you all. The first 2 days in India have been nerve-wrecking
as I anticipate what’s to come – but I’ve enjoyed the time to explore, rest and
mentally prepare. I will update you all on my first day of placement tomorrow.
Once again, thank you for taking time out of your day to
read my blog!
Until the next time..
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