CASI Student Blog
Happy International Women’s Day! It is only fitting to spend today in India with a team of women who know how to get things done!
I’ve been at Aravind Eye Care System in Madurai for the past few days and it has been a whirlwind of visiting the hospitals, meeting with Aravind staff, and attending a weekly “journal” session where staff share new research via web conference with the different hospitals across Tamil Nadu. Today I was able to attend an eye camp outside Madurai with 10 “sisters” (nurses) and 1 doctor. We piled into a bus at 6:15 in the morning, stopped for breakfast around 8 am and by 9 the camp was set up and receiving patients. 136 patients came today and this was considered a “light day.”
Patients are greeted outside the camp and receive their initial paperwork. They then rotate through the six or seven stations depending on their diagnosis. Many receive glasses on the spot (I could have photographed the team measuring and grinding the glass all day long). Those who need cataract surgery receive a wristband indicating which eye is to be operated on. The patients heading for surgery wait in the back of the camp, eat lunch, and then return with the Aravind staff to the hospital in Madurai. Today 22 patients returned with us on the bus. They will spend the night at the hospital and tomorrow morning will go in for cataract surgery. By the end of tomorrow the surgeries will be completed and they will be taken back to their village. In a few weeks they will receive a follow up visit from an Aravind team so there is no need for them to return to the city.
The process is smooth and works like a well oiled machine. Last year there were 1,507 regular comprehensive eye camps organized by Aravind; 339,416 patients were examined; 73,698 advised glasses; 61,540 glasses ordered; and 46,562 glasses delivered on the spot (the rest are received by speed post). The sisters are trained in their speciality – customer service (meeting, greeting, and paperwork), diabetes testing, refraction, glasses fitting, patient records and more. I’m including a few photographs in the slide show below that attempt to illustrate just how neat it was to be there today!Click to view slideshow.
In other news, it’s been a blur of a few months at CASI and we are well on our way to announcing our 2015 CASI interns! We had a full team of support from alumni readers, committee chairs, and former CASI interns leading interviews this year! Feeling so thankful all around.
I could write forever but I have an early morning tomorrow with our 2014-15 Sobti Family Fellow Vignesh Selvakumaran!
More coming soon!
I came to realize while staying here in India, my perception of India is very different than other natives of India. It falls more in line with more conservative parts of India, like Madurai and parts of Tamil Nadu. This probably comes from the fact that every time I come to visit India, it is always to visit my family, which lives predominately in rural areas of Tamil Nadu. I was talking to another fellow here at Madurai, and his view of India is the exact opposite. His family all lives in Bangalore and Mumbai, so his perception of India was extremely liberal. I think after traveling to various parts of India, we both have reached some sort of middle ground and have realized how vast and diverse India really is. Parts of India have really progressed and can’t be differentiated from any other major city in a drastic way while some parts have stuck to their roots. It is really amazing. The vastness of people and having such a successful democracy is something to admire, and I am really proud of that. This blog post, along with the next one, are really about how drastic of a difference those lives are.
In December, I had the chance to explore Mumbai with my family during the winter holidays. The first couple of days I spent very little time in the city, heading to a local retreat in the mountains called Mathuran. Mathuran was a nice break from the city
life, no sounds of auto’s blasting their horns; in fact, no automobiles at all. That’s right, Mathuran forbids automobiles, so in order to get to the top of the mountain you have to either walk to the top, take the train (2 hours), or ride some nice horses. On the way up we decided to go by horseback.
The resort had many scenic views of the local area and the mountain had a cool temperature which was welcomed by me personally. This mountain is also known for the monkeys, which outnumber the people that live on this mountain (relatively less, very rural). Overall the trip was relaxing and slow, which is exactly what the doctor ordered for me.
The following couple of days I stayed at my uncle’s flat in Chembur, Mumbai, India. Chembur is a heavy residential area in Mumbai.
On the first day exploring the city, my cousins took to the local mall, and wow! I thought the Christmas/New Year’s shopping spree was isolated to the Western Hemisphere, but boy was I wrong. The mall was Black Friday madness (without the sales) and ridiculously huge. Growing outside the Greater Philadelphia Area, I would compare it to King of Prussia. Very similar style of stores with all the bells and whistles. I really didn’t buy much because the prices were also highly inflated, but I did get the opportunity to drink some coffee at my first Starbucks in India. They even had the special Christmas flavors in stock. You could walk into this Starbucks and think you were on 34th & Walnut store (interesting Fact: Starbucks is franchised by TATA throughout India).
The mall also had a TGI Friday’s, I ended up eating all the American Food I could possibly eat. Who knows how many opportunities like this would come up, am I right. We also went bowling within the mall, I felt like I was in the suburbs of Philadelphia once again.
The following day, I had the chance to explore South Bombay. A lot of Mumbai’s attractions are here, including the Taj and the Gate of India. Those attraction, though grand, really didn’t catch my eye as much as the trip there. Most of South Mumbai looks architecturally similar to parts of London, which makes complete sense. The Indian Government is trying to preserve that architecture throughout Southern Mumbai. You can really see and feel the wealth of Mumbai in this district. The Taj uses Jaguar cars to pick up their guests; the local shopping is all high end; you have access to stores like Swaraski Crystal and Tiffany’s Co. It is truly amazing. The discrepancy of wealth in India became obvious in Mumbai. When flying out of Mumbai you can see the slums surrounding the airport, but then Southern Mumbai makes you forget all about that. It feels like a gated community.
I had a really enjoyable time in Mumbai. I got to experience another side of India totally different from Madurai. It seemed very Western in many ways, but Indian at heart (that the slogan of the Mumbai International Airport).
One of two doctors doing glacoma screenings.Earlier this week I had my first exposure to the eye camps here in Madurai. Both me and Avilash, a Fulbright Scholar who is also working at Aurolab, had the opportunity to go visit one this past Sunday.
Eye Camps are usually held in rural areas; however the one we took part in was just on the outskirts of Madurai at a local temple. The temple/ashram was founded by Mata Amritanandamayi – you may know her as the Hindu spiritual leader who gives hugs to people of all walks of life.
At the ashram, all the workers started the day with breakfast. After breakfast was served, the 15 nurses and 2 physicians went to work setting up the camp. Within a couple of minutes, the whole ashram was transformed into a eye screening and diagnoses center- equipped with 10 separate stations for various visual screening purpose. You had basic stations for registration and selecting glasses, while others were a little more sophisticated – including dilation and glaucoma screening. Each station had a number associated with it and was organized in an easy to use fashion. At about 8 PM the locals started rolling in. It was nothing short of amazing, about 2000 patients probably when through all stations in the matter of 4 hours. The physicians had the opportunity to see all the patients and those suffering from cataracts were sent to the main hospital to receive surgical treatment via shuttle bus. It was amazingly efficient and screened for a majority of eye related diseases. I personally thought this was the biggest bright spot of what Aravind had to offer.
When I left Delhi last August, I never imagined I would be back so soon, riding autos through the traffic-jammed streets of Bangalore, admiring the Gateway of India alit at night in a million colors, visiting Mahatma Gandhi’s ashram in Ahmedabad, and learning once more about the incredible potential of this beautiful country.
From December 28 to 31, I took a Global Modular Course on Technology and Entrepreneurship in India taught by Professor Kartik Hosanager on the IIM-Bangalore campus with 30 students from Wharton (executive MBA, full-time MBA, and undergraduate) and 30 students from IIM-B. We heard from executives of Flipkart (India’s version of Amazon), Myntra, Zoomcar, Uber, and Teamlease on the growing opportunity for e-commerce, tech, and mobile startups. Although India has the third highest number of smartphone users and the private and public sectors have increased incubator and accelerator support for startups, India still suffers from poor transportation infrastructure, stringent hiring laws, and lack of quality higher education to serve the needs of its 1.2 trillion people.
After my course ended, I began fieldwork for my Wharton Research Scholars thesis on frugal innovation, funded by a Wharton research grant. Under the guidance of Professors Devesh Kapur and Saikat Chaudhuri, I am conducting case studies of healthcare companies that have achieved high performance under cost constraints through process, product, and business model innovations.
My site visits included two of the most cited sources of “frugal innovation”: Narayana Health, which runs cardiac and multispecialty hospitals in Bangalore, and Aravind Eye Care Hospital in Madurai. NH is a highly scaled operation with 29 hospitals in 17 cities, which provides surgeries for 1% of the cost of similar surgeries in the US. NH has achieved one of the lowest mortality and infection rates in the world (around 1%). A surgeon gave me a tour of the pediatric ward and the telemedicine facility, through which they have offered 53,000 free consultations to people from around the world.
I also had the great privilege to speak to NH’s founder Dr. Devi Shetty, who served as one of the primary caregivers for Mother Teresa in Calcutta. I then spent two days at the Aravind complex, during which I met up with Vignesh and toured all the medical facilities as well as Aurolab, Aravind’s in-house lens manufacturing company.
Although NH and Aravind have both achieved incredible success by international standards, they have different operational models – for example, Narayana is a for-profit which provides subsidized operations to 13% of patients through the microinsurance plan Yeshaswini, while Aravind is a financially sustainable nonprofit that treats 70% of patients free of charge through payments from wealthier clients, who receive more comfortable amenities, but the same quality of care.
Later in my trip, I was able to interview Raghu Dharmaraju, VP of Embrace Innovations, a social enterprise that produces low-cost baby incubators, and compare his marketing approach with that of a large multinational, GE Healthcare, in their launch of the Lullaby Warmer. Both and Ashish Gupta, former Global Product Manager for GE, commented on the difficulty of tailoring their price point and distribution strategy to meet the needs of the Indian consumer.
On January 8, I spoke with Professor Anil Gupta from IIM-Ahmedabad, who founded the Honeybee Network and the National Innovation Foundation to source, license, and commercialize grassroots innovations (e.g. agricultural machinery, herbal remedies, etc.). Although the government has become more receptive to innovation, Gupta said that it is still difficult to secure funding from traditional sources and shift engrained cultural mentalities, which prioritize engineering as a field of study and job security over risk-taking and the creative arts. The NIF holds Shodhyatra (journeys of exploration) to meet innovators in remote areas, tests scientific methods in the Sristi laboratory on the Gujarat University campus to identify traditional processes for patenting, and holds competitions to find new ideas from children, the most open and free-spirited segment of the population.
India is at such an exciting time in history with huge commercialization potential for basic business ideas from developed countries adapted to the Indian culture as well as grassroots innovations that can serve the BoP (bottom-of-the-pyramid) market through unique cross-subsidization models and knowledge of the local landscape. As much as I am glad to be home, I know that India holds a special place in my heart and I am grateful to have spent a warm winter break amazed once again by the hospitality of its people.
I have visited a lot of hospitals and seen numerous surgeries performed throughout high school and college around Philadelphia. I even had the opportunity to see a cataract surgery performed in Bryn Mawr Hospital. Usually the average cataract surgery lasts 1-2 hours, requires a full operating room staffed with 3 or 4 nurses and an ophthalmologist. That is most certainly not the case at Aravind.
Aravind has about 10-12 operating rooms in their main hospital. On any given day, four or so may be dedicated solely to performing cataract surgery. In each operating room there are usually two operations going on, which means two doctors are stationed in each operating room. The doctors’ sole task is to perform the surgery. Everything from the patient arriving at the hospital, to getting gowned and showing up at the operating room is organized and operated by other staff within the hospital. This makes the system extremely efficient. The magic amount of time it takes for each surgery: 10 minutes.
Each physician will probably perform 50-100 surgeries in a given day. This is kind of amazing, especially considering they need to perform more surgeries due to the influx of patients from both Madurai and outside the city from their eye camps.
These operating rooms are pristine too, they have the latest technology (Alcon’s latest phaco-machine) and everyone is in the proper attire, which I cannot say for in the US- there have been numerous reports and studies that claim hospital staff within the US are not following the proper protocol for attire and hygiene.
I had the chance to watch several cataract surgeries along with seeing a cyst removal from a patient’s eye. Overall I was extremely impressed by their operating room layout and organization of hospital resources.
On another note, one of the more interesting organizations I have been reading about while I was in India is ENABLE. It is an open community that creates prosthetic limbs for children using 3D printers. Because children are constantly growing, children who are missing limbs need replacements to keep up with their growing bodies. This means a lot of money is spent on prosthetics especially as a child. 3D printer technology is a possible solution. It is extremely cheap to create prosthetics with a 3D printer, it just requires experienced engineers and doctors working together. As I have been working in Aurolab, I noticed they had a 3D printer available and one of the other interns at Aurolab also has experience with 3D printer technology. So both of us will be working together to try to get prosthetics to children in India who are in need.
I unfortunately cannot upload picture from my room in Madurai thanks to the slow wifi. I should have some upload later this week when I get access to my work computer. Next week I want to dedicate a post to my awesome visit to the eye camps here in Madurai! Stay tuned!!!
CASI Student Programs Annual Open House
Wednesday, December 10, 2014, 2 pm – 5 pm, 3600 Market Street, Suite 560
The Center for the Advanced Study of India (CASI) at the University of Pennsylvania provides funding and support to current Penn undergraduate and graduate students to travel to India and conduct independent research and participate in volunteer internships based at selected CASI partner organizations. CASI also offers a nine-month post-baccalaureate fellowship, to support a recent Penn graduate to conduct an independent research project in India. Since 2007, CASI has provided funding to over 100 Penn students. CASI internships are made possible through the financial support of Penn’s Office of the Vice Provost for Global Initiatives in conjunction with Penn Abroad and Penn’s International Internship Program (IIP) and through the generous support of CASI donors. The December Open House is an opportunity to meet with past students to learn more about their experiences in India and discuss the application process for CASI Internships, Travel Funds for Research, and the Sobti Family Fellowship.