The Essence of Setting up a Tertiary Eye Care Centre

When one draws a mental picture of a tertiary eye care Centre, it essentially involves a large building, neat interiors, spacious waiting halls to accommodate a heavy load of patients, all available sub-specialities and a thoroughly supervised and compartmentalized staff system to take care of all of the above. No one will be wrong to approve this picture as a perfect model for such an eye care Centre. But is that all? May be not. The following story featuring a two and a half year old girl may enlighten certain other facets, which warrant attention.

Amirtha Kani M, daughter of Michael Kani M, a resident of Villupuram, Tirunelveli was presented to us when she was two and a half month old. The child was unfortunate in the sense that her mother was not blessed with an abundancy of breast milk secretion. She was kept on bottle feeding, the parents not knowing the formulation which could have simulated the natural counterpart. The result was a severe Vitamin A deficiency culminating in Keratomalacia in both eyes. Following a consultation locally, she was given Injection Vitamin A which caused the ulcer to heal. As an indelible footprint, the ulcer left a dense scar in both eyes and Amirtha Kani was deprived of vision. The bewildered parents rushed to the local ophthalmologist again for help, who advised them to consult at Aravind Eye Hospital, Madurai for further management.

At the Department of Paediatric Ophthalmology in AEH, Madurai, it was noted that the scar was occupying the central visual axis in both eyes. Creating a window in the periphery was thought to help the child and thus, an optical iridectomy was performed in the right eye. Following the surgery, Amirtha started to follow light. But this improvement was barely noticed by her parents and was not enough to enable Amirtha to lead a near normal life.

Exploring the possibility of making the left eye visually potent, she was referred to the Cornea clinic where she was advised Penetrating Keratoplasty for the left eye. On being asked why did he agree for a second surgery when he didn’t appreciate any significant improvement following the first, Mr. Michael says, “It was because of two unseen forces. One was belief in God and the other, faith in Aravind eye hospital. My faith in the hospital was consolidated by an extensive counselling done by the chief of the cornea clinic himself, Dr. M. Srinivasan.”

However, there was one other problem to be taken care of, as Mr. Michael recalls with tearful eyes, “I am a very poor village dweller sir. I couldn’t afford the cost of the surgery. I thought my financial incapacitation will force my child into blindness for ever and couldn’t help speaking my mind before Dr. Srinivasan. In response, he smiled, told me not to worry in a reassuring voice and made arrangements for my daughter to be admitted through free hospital. I couldn’t believe my luck. It is at that moment I knew fortune will smile at me.”

And it did. Following Keratoplasty in the left eye, Amirtha started smiling at her parents, she recognised them. Now at two and a half years, she carries out her daily pursuits, walks and runs around gleefully and is all set to be sent to school and lead a normal life.

There are three facets to be highlighted here. First, the local ophthalmologist referred the child timely and wisely. This underlines the importance of a referral institute maintaining an aura of faith amongst fellow professionals in and around the locality. Second, the consultants busy with the patient load spent time for speaking to parents at length. This act, despite the presence of a team of counsellors, suggests that nothing appeals the patient’s mindset more than a word of advise from the Doctor himself. Third, having a system for rendering free service to people who are economically challenged should be an integral part of a tertiary eye care centre. These three aspects, I believe, give completeness to a working referral Centre and along with the aspects described in the beginning, are the essence of setting up a tertiary eye care Centre.

Aravind lits a light of hope

When the gloom of poverty in a family was further darkened by an accident, Aravind lit a light of hope in the form of eye sight. The boy who had lost vision in one eye by “gilli” has now regained his vision.

Alamelu, a widow, who lost her husband 5 years back is living in Usilampatti, with her two children. Having no one to support, she was running a roadside fruit stall which generated a meagre income. Even that source of income was lost, when the local authorities removed her stall while clearing of the roadside encroachments. As a result she was put to untold hardships to mainatin the family.

As fate is not a miser in showering miseries, Alamelu received another blow when her son Ramkumar, studying in 10th standard, sustained an eye injury while playing “gilli”. The flying gilli had hit his left eye. Immediately he was taken to the government hospital at Usilampatti where his teared cornea was sutured and medicines applied.After a few days the injury was cured but the eye lost its sight. Alamelu’s sorrows went out of bounds. At that time, a neighbour advised her to take her son to the free section of Aravind Eye Hospital at Madurai.

Borrowing some money for bus charges, Alamelu set out for Madurai and came to Aravind’s free hospital. Dr.M.Srinivasan, Chief of Cornea Clinic, examined Ramkumar’s affected eye and informed Alamelu that there was a likelyhood of her son regaining vision if he undergoes cornea transplantation surgery. She immediately agreed for the operation.

Ramkumar who was admitted as in-patient underwent surgery the next day when a donor’s eye was received. After a few days when the bandage was removed, Ramkumar was able to see as before through his affected eye.

A streak of light suddenly pierced through the gloomy family of Alamelu. Her fears about Ramkumar’s future instantly disappeared. Both the mother and son with immense joy, took leave of Aravind heartily thanking its doctors, nurses and the eye donor’s family and the Eye Bank.