Penn Calendar Penn A-Z School of Arts and Sciences University of Pennsylvania

CASI Student Blog

Subscribe to CASI Student Blog feed CASI Student Blog
The Center for the Advanced Study of India provides funding and support to undergraduate and graduate students at the University of Pennsylvania to conduct independent research and volunteer internships in India. Funds for the CASI internships are made possible through the support of Penn’s Office of the Vice Provost for Global Initiatives in conjunction with Penn Abroad and Penn’s Global Internship Program (IIP) and through the generous support of CASI donors.
Updated: 21 hours 5 min ago

Through New Eyes

Sun, 09/11/2022 - 01:42

I spent a lot of my freshman year at Penn struggling with the whiplash of being in a brand new country. As this year comes to an end, I continue to struggle to navigate my changing relationships to India and the US. I was afraid that acclimatizing more to my new surroundings — learning to write dates in MM/DD, changing how I pronounce certain words, feeling more engaged with US politics — would pull me away from India, which felt like a betrayal to the roots that had enabled me to be at Penn in the first place. I wasn’t sure what it would feel like, this summer, to be back in my country but living away from home, in a different state with a different language, and as a changed person. In some ways, it felt like a test. I had to prove to myself that two radically different countries feel like home at the same time. The stakes are higher than they should be, but so it goes.

Tamil Nadu is very different from North India. As a Uttar Pradesh-born and Jaipur-raised North Indian through and through, I was excited for sinking my feet into a different part of India. There’s the obvious divergences: Tamil is a Dravidian language with separate roots from Hindi and Marwadi (as Sylvia, our Stanford ’25 linguistics friend explained), Dravidian temples are bright and colourful in a way that I’m not used to, Tamil politics and history is radically different in its values and historical movements from the reflection of Central politics that takes place in Rajasthan (as Tamil Characters, an essay collection I highly recommend helped me understand), Tamil culture – clothing, food, music – have a radically different history and flavor than Rajasthan. 

But there were subtler things: I felt different in Madurai. In Madurai, I felt safer walking around alone after sundown. I would order coffee from roadside coffee stalls, despite often being the only woman-presenting person there. I was even taking autos alone! It was so freeing and empowering getting to independently interact with the city in this way. Indian cities and public spaces decisively aren’t constructed for women, but the South does it a lot better than the North (Why are North and South India so different on gender?). I also realized I had been inhibiting myself, and looking at Celeste go on her two hour walks every night helped me realize that I was more capable of navigating these spaces than I thought. I know the reason I have avoided these activities at home has been, in part, because my economic privilege allows me to insulate myself from sexism, for instance, by avoiding public transit, in a way that poorer North Indian women simply cannot. Growing up in India had made me deeply aware of its many risks, but this summer helped me get the practice to navigate them regardless. I’m walking away from these few months feeling far more agency, independence, and confidence in India than I ever have before.

I also hadn’t travelled in India with friends all that much! Many of the trips without my family that I did go on were for school or extracurricular events. Through all of high school, I hadn’t really visited many places as things got busier, and I honestly don’t remember anything that happened before 9th grade. This summer, going around Tamil Nadu with Aravind, Suhaas, and Celeste, was just incredibly fun. We took Rs. 150 buses to Rameshwaram at 4 am by just showing up at Mattuthavani Bus Station. We talked for hours in sleeper buses to Coimbatore, before spending the night at Aravind’s grandparents. We climbed up foggy and slippery and gorgeous hills in Ooty (well, I quit halfway? but I think it still counts). We tried a wide range of experimental foods and music-filled restaurants in Pondicherry that I enjoyed so so much. It’s different travelling with people your age! It’s so great! Travelling with my co-interns to Rameshwaram, Ooty, Pondicherry, and Auroville, was definitely one of the highlights of my summer. I’m still incredulous at the randomness and loveliness and last-minuteness and unadulterated joy of all our experiences, which diverged from the academic/family trips in India that I made throughout my childhood. (If my parents are reading,  I’m so sorry, I promise I loved going to Kerala or Meghalaya or Chandigarh with you. It would just be nicer if you were 19 or 20 so we could, as the kids say, vibe a bit more?) 

While all the travelling was great, some experiences are more great than others. Two of my favorites are the following. In Rameshwaram, we took an auto to Dhanushkodi, the southeastern tip of Pamban Island. It’s an abandoned town that was destroyed in the 1964 Rameshwaram Cyclone, and it’s less than 20 km away from Sri Lanka. It’s mythologically significant, since it’s supposed to be the place where Hanumana lay the stones to create a sea bridge to Lanka. The beaches in Dhanushkodi were pristine and the waves rolled gently till my knees. I only accidentally let my slippers wash away twice. When sitting on the rocks near the water with our feet submerged in the water, Suhaas and I noticed at least 10 types of fish swimming near us. We found a beautiful small shop selling seashells and pearls of all kinds, and the Rs. 250 pearl bracelet I bought there now is a permanent fixture on my wrist. All in all, probably my favorite beach experience of all time. 

Visiting Auroville was also fascinating. Auroville is an experimental township an hour out of Pondicherry, based on principles of human unity and the pursuit of the Divine. The township sprawls around the Matrimandir, a huge gold-plated dome-like structure that was beautiful to see. But I wanted very much to get a richer sense of what the principles of Auroville actually look like in practice. In attempting to befriend some of the Auroville dogs (this, as you will notice, is a pattern), I ended up in a conversation with a 65-year old tata who frequents Auroville. He lives in a nearby village. After a long conversation, in which he very generously served me tea and told me about his family and old job as a teacher, he called a friend from his village with an auto, who actually took us into Auroville and gave us an inside tour! I’m still unsure how above ground this tour was, so I will leave some details hazy. We visited a music room with wind-chimes and xylophones and flutes, and there was something really healing about tinkering with so many delicate-sounding instruments and seeing them come alive. Auroville is really interesting: we saw spirulina farms, pony pastures, and residential and shopping areas. In some ways, it was exactly what I expected, with its focus on spiritual living, green spaces and diversity. However, Auroville receives significant government funding and makes a lot of its revenue from tourism, and it seems to primarily cater to financially stable Westerners looking for alternative lifestyles. Upon a closer look, it encourages complex questions about whether this actually is a feasible or redistributive way of organising society. Regardless, I’m glad I got to visit, and I’m glad it exists. Travelling during the summer has been a way of engaging more deeply with my surroundings and with India.

Toy train to Ooty Matrimandir in Auroville Our regular coffee stall Bus to Coimbatore Dhanushkodi In an auto at night Arriving in Ooty

I spent this summer in a country both familiar and unfamiliar. Being back in India felt easy in the way that my first year in the US didn’t. In India, I knew how much items in a store are supposed to cost, I knew how to talk to elders, I knew which street foods I can eat and what clothing makes me feel like myself. But I found most interesting about this summer was how I wasn’t scared of even the unfamiliarities of India. I wasn’t scared of signing up for the Tamil class for North Indian doctors at the hospital. I struck up conversations with the MLOPs and the lunch lady at Inspiration, despite being just as unsure of myself as I was a few years ago, when I would’ve been too hesitant to do so. I made strange but super fulfilling decisions like getting a spontaneous massage in Pondicherry with Sylvia or letting myself dance in front of strangers. Now at home in the radical discomfort of being in the US, when I was back in India, I sought out the discomfort and leaned into all that is unfamiliar. In this process of more bravely being myself in India, I am more deeply in love with it. I feel safer believing that the ties and love that bind me to my country won’t break just because I establish new roots in the US.

At the end, I don’t know if the test of the summer was about whether two countries can feel like home at the same time, but instead about whether I am capable of carrying the feeling of home within myself. This summer has brought me closer to the US, to India, and most importantly, to me. 

oontz oontz

Sun, 09/11/2022 - 01:26

We were handed several articles about Aravind Eye Care System at our orientation in early June. One article, titled “The Perfect Vision of Dr. V,” made us cringe throughout. After outlining the disappointments of modern life in Western countries, the author gave her solution: “There is a place you can go to find the answer: India. But don’t go to the megacities of Bombay and New Delhi or to the newly minted software center of Hyderabad. Go to the wild, wild south, mystic cowboy country, where gurus roam the plains, and where a John Wayne western turns into a Mahatma Gandhi eastern soon enough.”

Calling South India a wild, wild mystic cowboy country, where gurus roam the plains is…fanciful, to put it mildly. Madurai is far from a megacity, but it has a documented history going back over 2,000 years. And Tamil Nadu ranks highly as one of the most urbanized states in India. Another choice statement from the article was this snippet: “On the surface, India is a mess: It has a population of 1 billion, raw sewage on the streets, and traffic that moves at 20 MPH. But if you can look past India’s visual obscenity, you will see a country that is turned inside out.” Of course, the article had nothing but positive things to say about Dr. V and the Aravind model, which I wholeheartedly agree with. But it’s hard to not feel offended by the claim that India is a visually obscene mess.

  • Pondicherry’s tourism slogan of “give time a break” holds true.
  • A bird soars above the alley leading to Khuthbapalli. In the mosque, we received an insightful personal talk from Iqbal, the imam. His main message? Respect all those who sacrificed for you, especially your parents.
  • The Sacred Heart Basilica in Pondy.
  • Posters advocating against eve teasing (public harassment of women).
  • Murals along Pondy’s Beach Road
  • Aurospirul farm within Auroville
  • A cheerful goodbye in the hostel minutes before our bus left from Pondicherry.
  • Raja Ravi Varma painting “The Lady in the Mirror” in Chennai. Ravi Varma’s fusion of European techniques with Indian subjects was a major force in modern Indian art.
  • Chennai’s Government Museum is the second oldest museum in India, and it keeps delighting visitors to this day.
  • Krishna’s butter ball. Sliding down the slope of the rock and trying the salty lime sodas sold at its base made my inner child very happy.

When Laura interviewed me back in February, the question of “why India” inevitably was asked. This is a question that I have since gotten over and over, and my understanding of what India means to me has changed drastically. The easy answer to “why India” is “why not”? Learning to say yes to new things is an ongoing adventure, and it’s one that never loses its thrill.

When I reflect on my travels in India, my mind’s eye sees beauty that could not be properly depicted with any pictures. Sometimes it feels silly to even try. Many places, especially temples and ashrams, prohibit photography inside. Prior to entering the Sri Aurobindo Ashram in Pondicherry, a guard checks every visitor to see if their phone has been powered off. Inside the ashram, silence is expected. With no ability to take photos or verbalize your thoughts, slipping into a contemplative state of meditation in the ashram comes easily. The feeling of peace is profound.

At other times, my phone was overheating and temporarily refused to switch on. In Mahabalipuram, the sun is brutal and shade is scarce. It was the only place I visited where I saw people carrying umbrellas for relief from the heat. So I felt some comfort that my misery (at being a puddle of sweat) was in good company. And then there were times, like when I was in Delhi’s stunning Sunder Nursery at dusk, where my phone and portable charger both died after a long day of adventures. After taking tons of pictures at the nearby Humayun’s Tomb, it was oddly freeing to soak up as much as possible with only my eyes.

  • Humayun’s Tomb
  • The Delhi-Topra Ashokan Pillar in the Feroz Shah Kotla Fort
  • Gurdwara Sis Ganj Sahib in Old Delhi, marking the exact location where Guru Tegh Bahadur was beheaded for refusing to convert to Islam.
  • Gurdwara Bangla Sahib houses a sarovar, a large pool believed to have healing properties. This was another place where photos were strictly not allowed inside.
  • The moat of the Purana Qila. Because of August 15th (Independence Day), all Archaeological Survey of India (ASI) sites were free for both Indian nationals and foreign tourists!
  • Mughal architecture is designed to impress.
  • One gate of Jama Masjid. Dhivya recommended the mosque as a must-see, and the gentle rain made being barefoot much more comfortable.
  • Morning view from Jama Masjid’s tower. In the distance, you can see the Shri Digambar Jain Lal Mandir (oldest Jain temple in Delhi) and the Red Fort.
  • Looking out at a Delhi metro stop. Definitely much cleaner and safer than any urban public transit in the US!

Delhi was my first time exploring a city in India alone, so Laura connected me with Ruchika at UPIASI as a point of contact if I needed anything. Ruchika kindly arranged my accommodation at the India Habitat Center and my transport to and from the airport, which made me feel completely at ease and welcomed. Because I visited the capital close to the 75th anniversary of independence, the city was full of patriotic fervor and under more security than usual. Attractions like India Gate, Rashtrapati Bhavan, and the Red Fort were all blocked off due to safety measures for Independence Day. Despite the closures, Delhi quickly became one of my favorite cities.

There, I continued to eat my way through Indian street food (chole bhature! chuski! kulfi falooda!) while maintaining my luck of avoiding any food-related illnesses. I also had the pleasure of joining langar (free communal meals) at both Gurdwara Sis Ganj Sahib and Gurdwara Shri Bangla Sahib. As volunteers made their rounds to constantly pour more food into outstretched hands, I contemplated the three pillars of Sikhism: an honest living, to share with others, and to focus on God. These values of hard work, giving back, and keeping a greater spiritual purpose in mind define my general takeaways of what makes India so special.

On my last day before returning home, reading the inscription on the Indira Gandhi Memorial resonated deeply with me: “A poet has written of his love — ‘How can I feel humble with the wealth of you beside me!’ I can say the same of India. I cannot understand how anyone can be an Indian and not be proud — the richness and infinite variety of our composite heritage, the magnificence of the people’s spirit, equal to any disaster or burden, firm in their faith, gay spontaneously even in poverty and hardship.” Indeed, how can you have the fortune to experience India and not be in awe?

  • Memorial to Indira Gandhi, the first female Indian PM, with a moving inscription on Indian pride.
  • The Rajpath leading to India Gate and the Rashtrapati Bhavan was totally closed for August 15th. India Gate still shines like a beacon.
  • Statue in Mahatma Gandhi Park, which is close to the Chandni Chowk metro station. The English inscription reads “where he sat was a temple, where he walked was hallowed ground.” Not pictured: the intense morning cricket match on the grounds.
  • Gandhi’s talisman at the Raj Ghat memorial. Prior to viewing the samadhi, you must remove your footwear (chappals) here.
  • Gandhi’s final resting place.
  • The Indian tricolor of saffron, white, and green. Seen in the Lok Nayak Jaya Prakash Narayan Memorial Park in Delhi.
  • Sign outside the Madurai airport celebrating the 75th anniversary of Indian independence. The slogan reads “Azadi Ka Amrit Mahotsav.”
  • The National Gandhi Museum. A Chinese scroll with a eulogy for Gandhi is displayed next to envelopes covering Gandhi’s visits to Tamil Nadu. The bottom left envelope commemorates Gandhi’s famous gesture of donning a loincloth in Madurai.
  • The wall displays Chiang Kai-shek’s 1946 calligraphy in memory of Gandhi. In the center of the room are Gandhi’s bloodstained clothing, bullets from his assassination, and a pocket watch he carried during his death.

Now that I’m back at Penn, life feels totally different. On weekends, backlot is always blasting music (the current song is the frat classic “Pepas” by Farruko) and parties rage across campus. In Madurai, the nightly soundscape was defined by a cacophony of honks and the reliable intermissions of chanted prayers.

Despite a busy schedule, I’m hopeful to stay connected to my CASI internship and continue broadening my worldview. Last week, Sylvia texted me the ticket link to her friend’s upcoming performance and discussion of Bharatanatyam dance at the Annenberg Center. Today, I have plans to catch up with Ihsan, who studied Tamil with Sylvia in Madurai. Ihsan came to Penn to present his PhD research at a conference on the performing arts of South India, where his area of focus is on the flood songs of Malabar. The collective euphoria of dance and music is just one shared thread across cultures, and it beats with the energy of any good oontz oontz beat.

Saying that spending time abroad changed me is on par with “let’s grab lunch together soon” as a Penn phrase that has become trite. Still, I can confirm that saying yes to a summer in India was among the best decisions I have ever made, and I am very down to grab lunch with anyone who wants to talk more.

Keeping Up With Control

Thu, 09/08/2022 - 22:13

Scientific research assures the world of causality with the aphorism that the results were generated in a “controlled” setting. When medical researchers test drugs or behavior on lab mice, they measure their diet, their sleep patterns, their activity levels, as well as treatment dosage. Petri dish specimens get to marinate at length in climate-controlled conditions, and make-up finds itself on blushing bunnies. Mimicking scientifically controlled systems in human behavioral research in the social sciences sets up a task that really throws caution to the wind over the possibility of extraneous factors coming by for casual contamination. Somehow, somewhere, psychologists, sociologists, economists, political scientists, and other social scientists alike decided to bring the controlled setting of rodents in cages to towns and homes to study if bed nets can reduce incidents of malaria.

Malaria bed nets (picture source: GEN news, 2019)

There’s always a risk of something, or everything, getting contaminated when a controlled experiment involves hundreds of people in a bustling urban environment. My research interest includes studying the effects of behavioral interventions such as cash transfers and phone nudges: both commodities that can easily be shared, distributed, lost, mismanaged and/or ignored. Seeking to understand the effectiveness of a minor injection of money or motivation into a household is like walking the tightrope of controlling for various extraneous factors, and managing to disentangle cause and effect in the neuro-cognitive correlates of socioeconomic status.

With the added complication of capturing amorphous social constructs in developing societies (see my previous blog post: Classifying the unclassified), social and controlled experiments mimicking the lab in the neighborhood really do deserve more attention, as well as acclaim, for the unlocked difficulty level.

Classifying the unclassified

Wed, 09/07/2022 - 16:29

This is my second year as a CASI summer research fellow, and my second year researching a complicated behavior phenomenon and community in my hometown of Mumbai, India.

This research is based in Mumbai’s Malvani neighborhood: the undefined borders of the same manage to pin the problem of assembling structure and amorphous meaning in social research. Malvani’s district borders are constantly changing: it’s predominantly migrant population constantly exploding and receding with COVID-related migrations, and it’s child population being the most dense in Mumbai city. “Shark schools” are private schooling enterprises launching in the neighborhood with extremely high tuition rates because the public school system cannot accommodate the burgeoning student population. Parents mostly work in service and small business sectors, with unreliable income frequencies and sources, and constantly changing perceptions and beliefs of their children’s long term education goals. There is no real constant in this dynamic community, making

Which category is it anyway?

Before the pandemic, parents hoped that their children would go to college, irrespective of gender, and now a shift in goals is evident with two years of schooling disruption. Through phone-based interviews, we tried to learn more about children’s home environments for home learning, care, and parent-child engagement. Implementing scientific and structured research also raised important problems that researchers don’t get to question enough: “this binary answer does not explain my complicated experience with my mental health” or “I do not understand all these different options because I don’t know what an ordinal scale is”. We ended up creating a practice questionnaire using enjoyment of Shah Rukh Khan and Salman Khan movies on an ordinal scale to ease participants into the rest of the interview.

Seemingly straightforward questions such as “how many people live in your household” were challenging to tackle: “do I include my aunt’s son who is living with us this year while his mom is in North India for work?”. A question that caused the most chaos was “what is your main source of income” and was often met with “it was running the shop last month, but this month I am a security guard five days a week and it pays better”.

These seemingly innocuous barriers to smooth interviews and data collection were eye-opening as a PhD researcher: using our carefully constructed and validated metrics still require adequate tailoring to be the right fit for the targeted population! Moving forward, constantly improving the quality of data collection practices should be imperative, and we should be up for the challenge.

What Even is Community Outreach?

Tue, 09/06/2022 - 10:20

Some of the most interesting experiences this summer have come from seeing the Aravind model in action in a very wide range of places. I’m interested in healthcare delivery, and it’s been fascinating to see the different meanings their mission takes in different settings. There are many ways in which components of a system must work together to realize a specific goal, and in Aravind’s case, the goal is eliminating needless blindness. In practice, this means finding and identifying the patients who need care but are currently outside the system, improving access to basic eye care solutions like glasses, building the pipelines to ensure patients get the further care and referrals they need, ensuring a range of cost options exist to cater to different people, providing high quality treatment and surgical care for complex conditions, developing a workforce capable of responding to the challenges of eye care delivery in a state of almost 7 crore people, and so much more. Vision centers, the many free and paid hospitals, community centers, Aurolab, the Aravind Medical Research Foundation (AMRF), and camps, are just some of the parts of this very complicated, interconnected system. 

I’m really lucky that my project allowed me to see these parts interact with each other and develop a more complete understanding of what it means to really care for patients. I worked with the glaucoma department at the hospital and the vision center (VC) team at LAICO. A vision center, as defined by the Aravind website, is a “small, permanent facility set up to provide primary eye care services to semi-rural and rural communities.” A running joke in our intern group as we picked our projects in the first few weeks was pointing me when anything even remotely vision center related came up. I find rural healthcare delivery and the pursuit of universal coverage really important and interesting, and seeing it in action at the VCs has been extremely rewarding. 

My project aimed to (a) understand the current problems in the glaucoma teleconsultation system for VCs, and (b) pilot interventions to increase the number of patients utilizing specialist glaucoma teleconsultation to follow up. Aravind has an unusual model of connecting all VC patients with doctors at the base hospital through teleconsultation, to make sure even the patients getting primary eye care are able to meet a doctor and get high quality care from the get go. My project guide, Mr. Gowth, who manages vision centers at Aravind, initiated a similar teleconsultation system for glaucoma, where new and review glaucoma patients can get teleconsultations with glaucoma specialists at the base hospital. Unfortunately, the numbers of glaucoma patients being seen through teleconsultation were consistently low, the data tracking systems for the project had fully broke down, and there wasn’t a comprehensive analysis for what changes can be made to improve the system. Here’s where I came in.

My work involved a lot of speaking with and travelling to vision centers, speaking with doctors and fellows and managers in the glaucoma clinic, brainstorming and analysing potential solutions, and attempting to strengthen the connections between the VCs and the base hospital for more complex care provision. I loved the diversity of what I saw, and it has inevitably challenged and widened my conception of what community outreach and public health mean. Here are some of my favorite places and experiences on this journey. 

[13 June 2022] Alanganallur Vision Center: The town of Alanganallur, thirty minutes away from Madurai, holds the first vision center that we visited. In many ways, it wasn’t what I expected. Since the founding of the center in Alanganallur more than twenty years ago, the VC technician and the coordinator have worked there. I volunteered to get my eyes checked, as a demonstration for the many new Aravind doctors and other interns on the trip with us. I very quickly learned that my current glasses needed at least some tweaking (I was told that my face is small and my glasses are big, which is why I can’t read the last line, despite having the right prescription). The staff were unequivocally experts at their job, in their technical skills, their knowledge of the local population’s eye needs, and their clear sense of ownership and responsibility for their center. We read comments from visitors from around the world dating back at least fifteen years in the guestbook, and we left some of our own!

[23 June 2022] Kariyapatti Vision Center: Suhaas and I visited the VC in Kariyapatti in a car with Gowth sir and Jhansi ma’am (VC Project Manager). We were instantly greeted with tea and a lot of warmth by the VC’s coordinator and technician. For the first hour or so, we sat around and observed, as the afternoon rush of patients was seen. Through this deeper observation, I learned a lot about the needs patients present with in primary care and how patient flow works in a VC. Later, we asked questions related to our respective projects, about E-See, glaucoma camps, and teleconsultation. Getting to see a second vision center in action really illuminated both the differences in how primary care is provided — like the specific center’s infrastructure, the nature of the surrounding area, the patient numbers it received, the experience and responsibilities of its staff — but also highlighted the critical role these centers play in the communities they are in. Asking the staff questions was an interesting experience, since Suhaas understands but does not speak Tamil, and I speak an Indian-ised English but don’t understand or speak Tamil. We communicated in this patchwork of languages, the four of us translating phrases for each other, but it felt just right (and also just so entertaining). In the (really fun!) drive back with Gowth sir and Jhansi ma’am at 8:30 pm, filled with conversation about their work that day finding a place for a new VC, his past visits consulting in Africa, and takes on modern workplace culture. Through this visit, I was filled with a clearer sense of the questions I need to answer. I understood a lot more why this work mattered, which fuelled me for the rest of the internship. 

[7 July 2022] Gandhigram Vision Center: This might have been my favorite visit to a VC, primarily because the VC technician, Sister Rajathi, spoke both Hindi and English fluently. This was also at a time where I was flowing with questions about glaucoma, based on conversations across Aravind, and getting some answers was so gratifying. What data do the VCs get from the base hospital and what do they collect independently? How long do patients usually wait after arriving at the VC? How many of the glaucoma review patients do follow up visits when they purchase medication? How long are the doctors actually present between 3 and 4 pm? The VC felt very different from the others I had visited. Early in the week, it was absolutely bustling with patients. Simply being present there deepened by understanding of and respect for Aravind’s VC model and also exposed me to the huge room for improvement in small things like data systems connecting the VC and the hospital. Suganya ma’am, a LAICO faculty and consulting team member, accompanied me on this trip. She drove me on Sister Rajathi’s Activa to the Saravana Bhavana we had lunch at and then to Chinnalapatti, a town famous for its unique cotton saris. Sitting on the back of the speeding Activa in the light rain, full of project answers and Kothu Parotta, I felt genuinely so fulfilled and excited about my work at Aravind.

[17 July] Aathikulam Camp: The medical camp I visited was held in a school in the Aathikulam locality of Madurai. Early in the morning, a group of MLOPs, doctors, and I boarded a hospital bus to Aathikulam to help the school staff set up the camp. There were so many different ‘stations’: registration, preliminary doctor’s exam, refraction, refraction for returning patients, IOP and ducts check, blood pressure measurements, final doctors exams, counselling, glass orders, and more that I’m definitely forgetting. Most of them were staffed by MLOPs, mostly trainees, who ran a really efficient and beneficial camp serving more than 400 patients. The primary problems the camp treated were refractory error (providing glasses) and cataracts (diagnosing and transporting patients for surgery). For more specialised issues, patients would be referred to the base hospital. One of my favorite memories from this summer occurred at this camp. Since my role was primarily observation, I was walking around and taking notes. I saw a single elderly man approach from the back end of the camp. He didn’t have an attender, had obviously compromised vision, and seemed quite confused. On approaching him, he asked me where to get glasses. When I didn’t understand this question in Tamil, he made the gesture for glasses. As the conversation progressed, the language barrier really became a problem, so I asked a boy waiting nearby to help me understand. The man hadn’t gotten a registration slip, so we walked together to the seating area for registration. Somehow, this didn’t seem like the end of the story. I came back to check on him when he reached the front of the line for registration, and after his vision test and his registration slip, I walked him to the area for a doctors’ examination. This started a camp-long connection — I walked him from station to station, held his hand while his eyes were dilated, and he called for me (papa – the Tamil word for beti or young girl) when I strayed too far for more than a few minutes. As we were referred from the refractory section to the doctor’s exam and back, we gradually understood that he wasn’t going to be given glasses or any other treatment. The doctors would send him back to the sisters, since he kept asking for glasses.The refraction sisters thought the glasses won’t really help because his vision was too damaged already. I found myself somehow trying to bridge the gap between the tata’s anxiety and desire for glasses and the doctors’ and sisters’ frustration, without speaking a word of Tamil. In this experience, I saw more closely how profoundly isolating and terrifying the experience of losing your sight and needing treatment is, especially for the elderly. Sometimes, there isn’t anything medicine can do, but that doesn’t make it any easier for the patients stuck in their suffering. At the end, the tata held my hand and walked me to his house. He lived right before the camp, which is why he entered from the wrong entrance. He introduced me to his grandchildren, saying “Rajasthan!” when pointing at me, and offered me lunch inside his home. It’s easy for me to forget the love, connections, and resilience underpinning patient and doctor experiences in medicine, but I am filled with gratitude every time I am reminded like this.

[So many visits!] Free Hospital: When we kept turning up at her office reiterating our interest in community outreach when we were picking our projects, Dhivya ma’am reminded us that community eye-care isn’t just the camps or the VCs. It’s also having the systems in place to absorb and care for the patients that the outreach efforts find. Every visit to the free hospital showed how different it was from the paid. It was a lot more crowded, loud, and significantly poorer in the patients’ health and incomes. However, the very fact that it existed and helped a huge volume of vulnerable patients for no cost was incredible. It highlighted a very different set of problems with community care — the need for making it financially feasible as a business to provide high-quality care to the poor. 

In order: Gandhigram’s waiting area, a selfie with the sisters in Kariyapatti, me getting my eyes checked in Alanganallur, and Suganya ma’am and the Activa in Chinnalapatti.

Back to my project. In exploring how glaucoma-based teleconsultation could be made more scaled up and effective, and in exploring how much it actually affected rural patients with respect to the costs to AEH, I was questioning how the different components in a system like this interact with each other. My pilot suggestion after all the research was changing the hours of teleconsultation from 3 to 4 pm to the full work day, by working with the department to let fellows see OP patients at the same time as teleconsultation VC patients. I often found myself losing confidence in the project: the pilot was difficult to implement and speculative, the past data collection was spotty, the approvals were slow, everyone wasn’t as enthusiastic about the pitch as I was. But working with Mr. Gowth made it clear that it was my responsibility to hope. That doesn’t mean I shouldn’t respond to evidence or take feedback, it meant that I had to, as a poster on his wall said, be aggressive about change and respond to the resistance. Not every idea will work, but if we have reason to believe it might, it’s our job to try. In the end, my pilot led to a 257% increase in the number of patients seen, an outcome I was very surprised but nonetheless really pleased about.

I care a lot about public health, especially in India. My internship at Aravind has been so influential for making real and visible all the textbook challenges that exist in community outreach and healthcare in poor countries, but it has also provided me with a shining example of why that care matters and how to keep believing in and fighting for a future where people can access it. I know I’ll remember what I learned this summer for a long time. 

Finding plastic in a dynamic State: Some possibilities

Sat, 09/03/2022 - 22:39

Plastic is political. Throughout the summer, in voices of experts, municipal workers and recyclers, there seemed to be a contest. There were technocratic solutions to the problem of managing plastics as well as positions that held that plastic processing infrastructures are inherently political. Within the latter category, NGOs, trade unions and workers were confident that any change in the system could only be possible with the acknowledgment of plastic and polymer as a structural issue linked to uneven urban development. Thus, through the summer I experienced plastic not only as vibrant matter (Bennett 2010) but also as a material that forges hierarchy and power, through the body.

Plastic in Mumbai helps us peer into infrastructure not just as a technorational system of management but also as dynamic relational entity that is composed of affective, social, and historical elements. Plastic is thus historical as well. In the many becomings of plastic, urban space is constituted as well. This is replete with negotiations, value, power, and leakages. Plastic, as an ecology of practice animates the city. “Planetary urbanism” (Brenner and Schmid 2011) is a useful rubric to think about such ecologies. “There are plenty of factors here. There is no micro level ground planning on how to manage waste”, a municipal official explains as I ask him about how the city deals with plastic waste. He continues to tell me about the lack of concrete data on the quantity of plastic waste that is produced.

Quantities and data become themes that repeat itself in bureaucratic conversations around plastic. Municipal officials who manage the city’s solid waste including assistant engineers (AE) and junior officers (JO), keep repeating that there is no translation of the limited data on plastics that is available into policy. “Plastic and waste largely have become optics. That is hurting the city.”, an official would tell me. Where the bureaucracy would speak in a manner of technocratic visions, workers in the field would often have a different take.

As I found myself hanging around a dry waste processing plant in Thane, I could see the range of practices that follow plastic. From the sorting of the different qualities of plastics and polymers to the re/valuation of the same, I found both the worker’s body and subjective expertise playing an important part. For instance, the monsoon season on paper indicated a higher quantity of dry waste, but as it was noted by my interlocutors, it is often the waste absorbing rainwater that makes it heavier. In fact, the pandemic has meant that workers take up new forms of expertise in the handling and management of waste.

Plastic extends beyond its uses, compositions, and aftereffects towards an ecology of practices. In my fieldwork this position has allowed me to broadly understand infrastructures, biophysical processes, technorational governmentalities, experiences of abjection and hierarchies of being. Often, waste and its circulation defined the structure of the urban space and the specific everyday politics. These structures are not crystallized and are composed of multiple nodes of human material relationships. For instance, the daily remuneration of a waste picker in Mumbai, is decided not only on the quantity of waste that they pick and sort, but also on the type of relationship that the individual shared with the municipality, whether they were formally employed or part of the vast informal workforce (also called volunteers), their gender and caste status. Within this dynamic system, there is a constant negotiation of value and risk which are further performed through leisure activities, everyday gossip, and religious codes.

The matter at the heart of the issue is how do we reconcile material flows to infrastructure? Plastic has been a useful rubric to understand this tension- how do we think of the material as an active agent that engenders political negotiations and refuses mechanisms to discipline. In trying to understand these structures and flow I realize there is also another movement. Plastic becomes not just an environmental hazard but a mask that the state wears. My question increasingly becomes: where is the state? Mitchell (1991), answering the same question refers to ‘structural effects’, where the difference between state and society become further complicated. Discipline, itself becomes a central organizing principle of such effects, and we find a need to “move beyond the image of power as essentially a system of authoritative commands or policies backed by force” (Mitchell 1991, pp. 93). Similarly, as I think of Althusser’s (1971) idea of the state apparatus, I think of plastics in Mumbai framing the argument at an everyday level, where it codes public culture and transnational flows.

References:

Althusser, L. (1971). Ideology and ideological state apparatuses. Lenin and philosophy and other essays. Trans. Ben Brewster. New York: Monthly Review Press, 1270186.

Bennett, J. (2010). Vibrant matter: A political ecology of things. Duke University Press.

Mitchell, T. (1991). The limits of the state: Beyond statist approaches and their critics. American political science review, 85(1), 77-96.

Schmid, C., & Brenner, N. (2011). Planetary urbanization. Urban Constellations, 1st ed.; Gandy, M., Ed.; Jovis-Verl.: Berlin, Germany, 10-13.

Liminal Spaces

Mon, 08/29/2022 - 14:33

Liminal space:

To be on the precipice of something new

But not quite there yet

To be frank, I did not know what a liminal space was before this trip. So thank you to Celeste and Manya :). But it’s a pleasant term to help shape this blog post rather than just call it a photo dump. Although it is primarily that. 

Long distance travel in India normally requires trains or buses over multiple hours to reach a specific destination: such as Courtallam, Ooty, or Paliyaputtam. These stations always served as perfect examples of liminal spaces: an in-between, a threshold meant to be passed through. But even at the destination, I felt this liminality.

I felt more transitory at our destinations than the travel stations. I could hazard multiple guesses as to why the Aravind experience is peculiarly fulfilling for me. But it distils quite simply into this: being on the edge of exploration. Despite destinations deemed as endpoints, these are places to pass through. Not to fully exist in. This Aravind experience passed through me, while I was in a constant state of flux.

This summer encompasses a variety of these escapades, whether it be self-determined or part of the internship. Courtallam and Ooty both felt as exploratory as did the vision centre in Kariapatti as did the Meenakshi temple. Identity exploration through misty mountains or religious revelation. Through the fascinating structure of primary eye care in vision centers to the sheer mass of healthcare at the base hospital, I am swept up in the fascinating organisation of Aravind.

These experiences create this continuous feeling of discovery, internal and external, constantly on the precipice. Hopefully, I don’t get acclimated to this.

But, by its nature, this feeling is one of disorientation. With insecure footing, there is something amiss. It’s easy to get lost in the shuffle of daily life. Jumping from responsibility to responsibility, from one step to the next, ignoring the tension that comes with holding on just a little longer… 

I was within and without, simultaneously enchanted and repelled by the inexhaustible variety of life.

-The Great Gatsby

This entire experience felt liminal. It was meant to be passed through but not to fully stay in. The next new exciting thing: running faster and stretching our arms out. Then one fine morning…

It’s strange to realise how much and how little time has passed.

Acclimation at Aravind

Mon, 08/29/2022 - 13:59

Hello again!

For this second blog post’s title, I wanted to take a page out of Into Thin Air. This is my acclimation process as I navigate different terrain than Everest.

On the Road Again

While my family and I usually visit relatives in India every other summer, it’s still a bit of a jarring but no less exciting experience being back. With so much happening around oneself, whether the differences are big, small, or unexpected, it’s hard to keep up sometimes. The lifestyle varies, the interactions are different, and the language, while familiar, isn’t ingrained.

Our baby cousin doing better at the puzzle than us

Part of (if not most (if not all)) of the experience is just absorbing it all in. The people, animals, cars, motorcycles, bikes, buses, trucks and autos were an adjustment… Just to cross the road. There are big adjustments and small adjustments from work norms and washing clothes to food and finding a good gym. From the formal shirts in the sticky heat, to the hot coffee after 6, you can find yourself grounded in the turbulent fish in the tank at work. Albi, our favorite fish, will sorely be missed. But besides the deep sadness of Albi’s passing, it’s been exciting exploring Madurai and forming connections with the various people, organisations, and food here.

Water + Plants People + Rocks Pizza + Aravind

From my fellow CASI interns to the bodybuilders to our fellow residents at our hostel, my experience is rich with the many fun and driven people around me. Small stories like cheese dosas and late night motorcycle rides connect us in deeper ways than we could’ve expected from this summer. But with the summer whipping by me in the wind, sometimes it’s nice to take a moment to just breathe.

Pretend it’s a Vermeer

I walked the streets and tasted the golden sun that lay across the city.

-My Name is Asher Lev

Just some alone time in Madurai helps me reset whether it’s at a Walker’s Club or exploring shops. It’s easy to get lost in the shuffle of your own thoughts in an environment as vast as this. But it’s also easy to get lost in the good company of others, the sleeping cows, and the hustle and bustle surrounding the brightly lit shops of Anna Nagar. On this episode of Lost, I guess I’m just wandering.

Plastic documents: Finding the state in material flows

Sun, 08/28/2022 - 13:23

The area surrounding the Deonar dumping ground in Mumbai is dotted with municipal trucks and small scrap shops. The number of these informal waste segregation units steadily rise as one moves closer to the dumping ground. At one end of the road lies the “600 tenement” dry waste segregation station. This is the formal segregation unit, (being operated under a partnership between an NGO and the municipality) and I find myself sitting in it.

It has been raining continuously for a few days now, and the walls of the station, although made of aluminum sheeting is leaking rainwater. Banners that detail how to segregate waste, qualities of dry waste and a blackboard etched with the daily work duties of segregators cover the walls. How does one make sense of plastic flows? I keep wondering, as I find myself amidst stacks of gunny sacks neatly filled with plastic. The station takes the shape of living breathing fluidic organism, that has a rhythm.

As my eyes wander through the segregated plastic, I notice a pile of documents that lie over the table in front of me. They are handwritten forms that detail the quantity and quality of dry waste that has been processed on that day. It is not the first time that I have seen such documents. Log sheets that detail the municipal worker’s duties, and daily waste accounting are non-digital that are thought to organize the flows of plastic. They are maintained for municipal accountability, although an officer would later tell me that it is very difficult to ascertain the total quantity of plastic waste that the city produces. Why maintain documentation then? I am reminded of Gupta’s (2012) assertion of writing and documentary practices as performances that produce the state. He writes that “bureaucracies are machines of the production of inscription. Of all the activities that go into the daily routines of state officials, writing is probably the most important” (ibid, pp. 141).

In an attempt to understand how documents, work in managing plastic within the city, I ask the station supervisor if I can photograph some of the documents that lie in front of me. She refuses, asking me to get written permission from the ward officials first. I, thus understand documentary practices as intrinsic to the flow of plastic in the city. Hull (2012) has similarly understood “kaghazi raj” (trans: the rule of paper/paper rule) as one that makes infrastructural processes produce the complex networked being of the state that controls knowledge circulations. In the lack of clarity of the total quantum of plastic waste produced, circulated and recycled, the municipality, thus, creates a class of experts through bureaucratic and lived means. The question then arises: how does one become an expert of material flows within the city? What role does the gendered and racialized body play in this performance?

On days that I accompany waste collectors on their morning run, I realize that plastic flows work neither as a completely rational-bureaucratic organization nor as an organic natural performance. While dry waste is collected separately, I could see the collectors using a gunny sack to carefully take out the better qualities of plastic such as PET and LDPE. A leaky dimension emerges, where community and labor influences and in turn gets influenced by bureaucratic structures. In this performance through which plastic gets circulated, there is a hierarchy of bodies that is dictated by gender and caste but operationalized by violence (both state and otherwise). Muslim migrants and lower caste women are relegated to the bottom of the pyramid, where they work the longest hours and circulate the lowest qualities of multi-layered plastics. Paying close attention to documentation, thus helps us in understanding plastic flows as “forms of governance and modes of surveillance being put in operation in the offices of petty bureaucrats or on street corners” (Das 2004, pp. 174). McKay (2012) has similarly looked at the ways in which documentary practices play a role in standardizing bureaucratic practice that enact and complicate questions that relate to the maintenance and regulation of bodies and materials.

Plastic flows has thus been a useful rubric by which one can further the inquiry into bureaucratic systems. Here, the question of both body and the organization of labor become central. Most of the negotiations that follow the plastic once it becomes discard, throws light on the double nature of the state as both rational and magical, giving space for people to experience, perceive and resist everyday violence. Documentary practices, it would seem produces partial and mobile forms of sovereignty, constituting subjects in the process.

References:

Das, V., & Poole, D. (2004). The Signature of the State: The Paradox of Illegibility. Anthropology in the Margins of the State. Ed. Veena Das, 3-35.

Gupta, A. (2012). Red tape: Bureaucracy, structural violence, and poverty in India. Duke University Press.

Hull, M. S. (2012). Government of paper. In Government of Paper. University of California Press.

McKay, R. (2012). Documentary disorders: managing medical multiplicity in Maputo, Mozambique. American Ethnologist, 39(3), 545-561.

Reflections and Goodbyes

Tue, 08/23/2022 - 22:17

Although I’ve been to India quite a few times before, saying goodbye this time was extremely difficult. My experience in India this summer was amazing. “Amazing” doesn’t even encompass half of the joy I feel when I reflect on my time in India. It was two months filled with constant exploration, exciting work, and quality time with family.

Some things I’ve already started to miss dearly are the convenience of autos! They were such a cost-effective way to get around each of the cities we were in, and I miss seeing the vibrant color they bring to the streets. I also miss eating the tastiest mangoes! During the summer, I had the opportunity to try a wide variety of mangoes and not one variety disappointed! I’ll miss all the delectable food and chai, especially as I’m now off the dining-plan and will have to attempt my own renditions of the amazing food I ate all summer. I’ll miss being able to head to the local flea markets and practice my negotiation skills with shopkeepers. Moreover, I’ll miss the extraordinary variety of Indian clothes and jewelry available at every corner. I’ll also deeply miss my extended family. Because this trip was taken without my parents, I had the unique opportunity to communicate directly with many members of my extended family. I formed so many close bonds and am thankful that nearing the end of my time in India I was able to spend a lot of time with them (this is part of what made saying goodbye so difficult!).

Lodhi Gardens Adventure

In terms of work this summer, working at PHFI was such a unique experience. As someone who has only had experience with clinical and wet-lab research, working at PHFI was completely different from what I was used to. Because of this, my internship was a great learning experience because I got to see a completely different side of how we can affect health through a non-clinical lens. Specifically, seeing how adolescent health was focused on in rural areas through school programming and peer education was very inspiring. It was such a different approach to what I’ve seen used to address adolescent health elsewhere, and the success of the program was extremely encouraging to see. In addition to my field work experience, I also had the opportunity to see how health was impacted through government support by learning about and contributing to policy briefs that are sent directly to the government to inform leaders about pertinent health issues and ways to address them.

The beautiful office!

Additionally, throughout my internship I worked on the “Let’s Fix our Food Campaign” which is a joint effort between multiple collaborators, including WHO, to empower adolescents with adequate resources and information to make healthy nutritional choices. As a part of this project, I was able to make materials for the workshop of this campaign directed for adolescents and contribute to the planning of the virtual workshop. Nearing the end of my internship, I also had the opportunity to participate directly in the workshop. I helped moderate the workshop and got to interact directly with the adolescents in attendance. It was also great seeing that the workshop materials I had helped make were being used to educate the adolescents about nutritional choices!

Let’s Fix Our Food Virtual Capacity Building Workshop

One of my biggest takeaways from my internship is the value of health education in preventing non-communicable diseases. I also learned about the immense value of approaching health in an interdisciplinary manner such that without government support for health projects and without peer educators and other trained adults (such as ASHAS and counsellors) working directly in the field to impact the health of local populations, it would be extraordinarily difficult to obtain similarly positive health outcomes among certain populations.  I feel lucky that I was able to play my own role in contributing to the health education of various populations on a variety of essential projects.

All in all, I am incredibly grateful for my time in India this summer. I learned to become comfortable with the unknown and embrace all opportunities for learning that came at me whether that be learning at PHFI, learning Hindi, or even learning how to navigate around the chaotic Delhi streets! I am extremely thankful to CASI and UPISAI for making this experience possible and supporting me while I was in India. I am thankful to my family for their support throughout my time in India, my co-intern Niki for being the best travel and work buddy I could possibly imagine, my supervisors at PHFI, and all the people I met along the way. This is a summer that I surely won’t forget!

Hope to see you again soon, India!

Once Upon A Madurai

Mon, 08/22/2022 - 09:16

In our last week at Aravind, we woke up at 6:15 am to go to a 7 am walking tour of Madurai. It was called Once Upon a Madurai, and it was organized by a company called StoryTrails, which Miral recommended to us. It was a very different tour experience from what you’d usually find in India, wherein you pay a tour guide outside a monument to walk you through its history. This was, as you’d expect from the name, a tour led by stories. We would stop in narrow streets near the Meenakshi Temple, and learn about the story of the Nayakkar king who moved their capital to Madurai to deal with a runny nose or the story behind referring to Lord Shiva as Sundareshwar or the history of the Jains in Tamil Nadu. 

Despite the extremely early morning and the rain, I loved it!! I have always been one for a good walk, a good tour guide, and a good story. As this summer comes to a close, I find myself returning to some questions I frequent. When you look back at a complicated, (only somewhat!) tumultuous experience, how do you assess whether it’s ‘net good’ or ‘net bad’, and do you need to? Is it okay to have hold onto the big stories, as you slowly forget the details and the daily feelings and the TikToks that sucked up so much empty time? How much of love is memory, and can you love an experience if you forget most of it? I guess they’re questions I return to only because I don’t have the answers (and also they’re pretentious and badly defined, so I often forget what I meant). For now, here is what I think: I don’t know exactly what to say about this summer, but I know there are so many memories, stories, and moments that I want to hold onto tightly. This post is a list of some of those stories. No specific order.

  1. In our first week here, we saw a little puppy outside LAICO. He seemed friendly and was super excited when I pet him! When we tried to walk away, he kept following me, so of course I stopped to play with him. 
  2. I was emboldened by the previous immensely positive dog interaction, and the next day, we decided to go to a different coffee stall than usual. There was an unfamiliar, very smiley stray dog there. I bought him a piece of cake from the store, and when he let me hand be near him and ate the cake, I briefly touched his head. I had misread the signals and I should have waited, and now, I had been bit by a dog. Despite my attempts to downplay what was already a very small injury, Suhaas and Aravind accompanied me on a high stress trip to AR Hospital in KK Nagar. They took selfies in the lobby while I had a rabies shot administered into my butt, and I learned a lot about the Indian healthcare system that day. 
  3. While we are on the theme of coffee stalls, I distinctly remember the days when the stall owners began to recognise me. My order wasn’t the most complicated, I asked for one coffee, and if I was feeling bold, I’d ask for less sugar and more instant coffee. At one point, the anna  behind the counter would see me and tell the tata to start making the coffee (with my customizations!), even before I said anything. It made me feel closer to this city, and like there was something of sweetness I was taking away from this stall, far more than just the coffee.
  4. During the second of my five vaccination pilgrimages to AR Hospital, Aravind accompanied me. On the way back, in the auto, we saw Suhaas crossing the street as he walked back from Spark Fitness, and he did not see us. I’m not sure why in retrospect, but the two of us thought this was remarkable and important and hilarious. We took a bunch of pictures of Suhaas walking. When we finally delivered the joke after letting it simmer for hours, it didn’t land as much as expected. But Aravind and I were still perfectly content being unreasonably silly and overjoyed at seeing our friend on the street, and I’m glad we leaned into the feeling. 
  5. I really loved Miral (a co-intern from Madurai who is studying design at Avantika University), but I may have loved Miral’s house and Miral’s cat Zozo and Miral’s family’s little treehouse even more. I remember writing in my notes app that day, very eloquently: “- The quietness – The sound of birds – Grass and big trees – Hammocks – Cat – Sunlight – Fabindia – Children painting on the wall”. What else is there to say? What else is there to want?
  6. There was a fish tank in the LAICO lobby. It had many black fish and one single, quiet, and significantly smaller white fish. Aravind, Suhaas, Miral, and I were infatuated with this white fish, and we named him Albus Bumblebore after his long whiskers. We visited Albi, as Albus Bumblebore was called by his friends and family, every day as we left LAICO. Eventually, Albi, who was probably quiet and slow because he was sick, died. The others discovered this before me and decided to not tell me, because I was having a rough week. As a result of this, I had to discover Albi’s little body lying on the base of the tank myself. Albi was a good fish, and we miss him every day. 
  7. This isn’t a story exactly, but one time I dropped my very heavy water bottle on the floor of the glaucoma department, dented it heavily, and all the 60+ year old patients in the area turned to look at me. Not the best time! 
  8. My pilot started with a 7:30 am presentation in this unused room in the glaucoma department. I received permission to start the pilot at 4 pm the previous day, so till then, I wasn’t sure if it was even happening. So getting to present a very new slide deck to almost all the glaucoma department medical fellows at a time when I’m usually asleep to kick off a project I care about deeply: it felt surreal in a good way. I went back to my room and napped right after that before returning to work at 9. 
  9. We really had so many excellent meals in Madurai. I particularly enjoyed Phil’s Bistro, an Italian inspired place with a whole range of Phil themed offshoots like Phil’s Juices; the first ever branch of the Murugan Idli Shop with its deservingly famous Ghee Podi Idlis; Zaitoon, with its spicy Middle Eastern food and lovely ambience; Appams and Hoppers, with the kindest staff and really tasty Sri Lankan food; Pizza Hut, less for the food and more for our antics there; and Madurai Bun Parotta Kadai, where we tasted Madurai’s famous bun parottas for the first time.
  10. The weekend that Aravind and Celeste were in Tuticorin, I bought tickets to a theatre production called Erotica, which promised to explore “4 short plays that will explore love, sensuality, and sexuality as experienced by the LGBTQ+ community.” I was really excited — I enjoy queer Indian storytelling, I want to get into live theatre, and I’d never been to anything like this in India. Suhaas was roped in to accompany me on this adventure. It was a bit of a shock when I found out that all 4 plays were more than 90% in Tamil (I called them before to ask! They said an English speaker could follow it! That was untrue!). I pieced together some parts of each story, but it turns out it’s hard to appreciate a dramatic monologue if you don’t speak the language. It was still great.
  11. We walked a lot in the rain. This one time, I really wanted to go to the Madurai Trans Kitchen, which is one of the few fully trans-run restaurants in India. It was raining heavily but it was too late for dinner at Inspiration, so we took the auto. I’m not sure why we decided to get dropped off a full 5 minutes away from the venue, but by the time we found the shop, I had stepped in two puddles and my shoes were soaked. Unfortunately, the shop closes before Maps says they do – they had some parottas for us, but that was all. I don’t regret going, because I actually liked the parottas, because I was so interested in its history, and because it feels so empowering to simply feel curious about something and just go explore it, regardless of how things turn out. 
  12. While walking on the street after a thwarted Jigarthanda run, we saw a sign saying Bombay Kulfi next to a very narrow alley. I was craving kulfi but not enough to explore shady dark alleys, so of course I made Suhaas walk in first. I am pleased to report that we are both still alive and that paan and almond and pistachio are, in fact, excellent kulfi flavours.
  13. Sylvia and I got a spontaneous massage in Pondicherry!! We saw a massage parlour along the street, felt creatively inspired, and then got an hour long Balinese massage. The place we went to was right next to a crowded street where something resembling a wedding procession was happening, which isn’t the ideal massage setting, but it was still so much fun and makes for, in my opinion, a great story. 
  14. Gunjan didi (a PHACO fellow who worked with Celeste) brought us cake on our last day! It was really tasty chocolate cake, and somehow, right before we left, we figured out how to break into the kitchen and keep the cake in the fridge. Everyone else left before me, and I ate a lot of chocolate cake for dinner while missing them on my last Saturday night in Madurai.
  15. Most of my favourite moments this summer were just chilling with Celeste, Aravind, and Suhaas. On my first day here, Celeste and I talked for five hours straight. Aravind, Suhaas, and I would watch Bojack Horseman after work, prompting super personal conversations about ourselves right off the bat. I remember walking to Lassi House with Celeste so she could try mango and badam lassis, and Suhaas and Aravind joining us there after leaving the gym and needlessly flexing right in our faces. Seeing everyone at lunch every single day and checking in about our days and playing Egyptian Rat Slap and photobombing Aravind’s selfies and making silly inside jokes — that was the backbone of my summer, and two weeks out, I miss it much more than I expected to. 
Miral and Zozo Friendly Puppy Albi Sightings AR Hospital post Vaccine Suhaas from the Auto Us at LAICO! A Madurai Street Near Meenakshi Temple The StoryTrails Tour The View from Our Hostel a series of pictures from our time in Madurai

There was a lot to this summer. I am still working through my experiences, condensing the things I learned and want to take into the future. I really enjoyed my work (more on that later) and thought it challenged me to think of myself and of primary healthcare differently. In many ways, working at the Aravind Eye Hospital in the beautiful city of Madurai was exactly what I needed this summer. I can say with confidence that it was definitely a net good time. I intend on holding onto these stories as tightly as I can, because to me, this is what love feels like.

A Road trip Across India: Exploring New States & Partaking in Festivities

Sun, 08/21/2022 - 18:39

Well before we departed for India, my co-intern and I made a long list of places and things we wanted to see. Luckily, we both had equally adventurous spirits throughout this trip and hit most of our goals, with additional surprises! In this blog, I’d like to take you on our “road trip” across India!

First stop: Gurugram, Haryana

How we got there: Flight from JFK to Delhi

Of course, the first stop on our road trip, straight out of the Indira Gandhi airport was our accommodation in Gurugram- the city where PHFI’s office is located. Gurugram itself does not offer too many historical site-seeing locations, but it’s a beautiful developing city.

Must see locations:

Cyberhub: I highly recommend the café called “Theos” for wonderful pastries! You can easily get here with the Sikanderpur rapid metro line if you’re commuting from Delhi. Otherwise, autos are your best friend to get around the city.

  • Cyberhub meal
  • Sikanderpur station

Worldmark: Here, check out the restaurant known as “Dhabba” for some fabulous kadhai paneer. At night, they have a beautiful ambiance with live music playing. My co-intern and I frequented Worldmark to work there on our virtual workdays!

Ambience mall: This is one of the most impressive malls I’ve seen! It has a total of six floors and an endless variety of shops and food stalls. This is where my co-intern and I first ran into a shop known as “Haldiram’s”. This is a classic food stop for all as here you’ll find all kinds of variety of chaats, pani puri, chole bhature, etc.

  • Ambience Mall
  • Ambience Mall
  • Haldiram’s
Second Stop: Damoh & Panna, Madhya Pradesh

How we got there: Gatimaan express on the way there; flight back.

Our second stop on our trip in India was our field visit to Madhya Pradesh. Though this trip and our visits were thoroughly detailed in blog #2, here’s a quick list of where we went: Orchha Fort in Jhansi, Khajuraho temples near Panna, and the Dhuandhar falls in Jabalpur.

  • Orchha Fort
  • Dhuandhar Falls
  • Khajuraho
Third Stop: Ahmedabad, Gujarat

How we got there: Flight; Delhi to Ahmedabad

My co-intern and I made the decision to visit Ahmedabad as my co-intern’s family is based there. Though our trip to this beautiful city was brief, I had the opportunity to immerse myself in an entirely new place, and one that I would likely not have the chance to visit on my other India trips. When visiting Gujarat, I would highly recommend you visit the local shopping locations (as detailed in blog #3).

Step well in Gujarat Fourth Stop: Mount Abu, Rajasthan

How we got there: On our quick trip to Gujarat, we had also planned to make a trip to various locations in Rajasthan. With my co-intern’s wonderful family, we made the long 11-hour trip from Ahmedabad all the way to Jaipur. Before we got to Jaipur, we spent most of our day at Mount Abu!

Mount Abu is a hill station in Rajasthan and sits very close to the border of Gujarat. It is a part of the Aravalli range which begins in Delhi and ends in Ahmedabad. Our stop here offered a refreshing change in climate from our daily 90℉ + temperatures, to a settled temperature in the 60s. Moreover, on our trek up the mountain, we had a whole host of stunning views: from the beautiful waterfalls we passed to the foliage down below, being that high up among the clouds was amazing! Once we got up, we saw the Nakki lake. We hopped in a boat up here and the lake appeared slightly ominous. This is because it was difficult to see the edges of the lake due to how foggy it was up there. Eventually as the fog cleared up, we gazed around at the stunning heights of Mount Abu as we were located smack dab in the middle of the hill station.

Fifth Stop: Jaipur, Rajasthan

How we got there: Directly from Mount Abu, we made our way to Jaipur by car.

Must See Locations: When we first arrived in Jaipur, we realized its nickname, “Pink city” was true to its actual appearance. This is because many of the buildings are actually painted pink! Apparently, this color was used uniformly for many buildings because it represents hospitality.

Jaipur has a whole host of site seeing locations to visit! We only had one full day in Jaipur, but we still made the most of our opportunity by visiting some of the most historically famous locations.

Albert Hall Museum was our first stop. This museum was built in Jaipur many years after the construction of Jaipur’s prominent forts. Despite its later construction, its architectural features still align with many of Jaipur’s palaces. Though we weren’t able to make it inside due to time constraints, the beauty of its exterior was a must see!

Amer fort: Next, we headed directly to Amer fort. A guide told us that having seen Amer Fort, we’d toured more than 50% of Jaipur- this is how historically significant this fort was! For those familiar with the Mughal emperor Akbar, this was the home of his wife Jodha! Amer Fort was serenely beautiful and massive. It’s masterfully situated atop hills that way the inhabitants could see any incoming assailants from below, but in modern day times, it offers gorgeous scenery. Within the fort we also saw the sheesh mahal which is one of the most famous attractions within the fort. Here we saw the walls adorned with mirrors and beautiful stones.

After descending from Amer fort by car we then ventured to an official Jaipur tourist shopping area where we saw many handicrafts of Jaipur as well as the block printing technique.

Hawa Mahal: We got to see the Hawa Mahal from the outside both during the day and at night. It’s yet another stunning piece of architecture in Jaipur with the characteristic pink exterior!

Jal Mahal was another quick stop while we were on the road. This was a unique palace because it’s situated atop a lake. The views from afar were beautiful.

Sixth Stop: Delhi NCR

The second month of our internship was largely spent in Delhi which gave us the opportunity to easily explore the rich history of the city in the heart of India.

How we got there: When commuting to and from Gurugram to go to PHFI, we primarily used the yellow metro line. Otherwise, to get around the city, we relied on autos.

Must see sites:

Qutab Minar: We got to this UNESCO World Heritage Site by auto directly after getting of the Qutub Minar metro station. The complex was large and dominated by the large minar which is also referred to as the “victory tower”. You should budget at least 30 minutes here as there are many other buildings to check out within the peaceful complex!

Lotus Temple: The lotus temple is a gorgeous Baháʼí House of Workshop. Its lotus like shape and bright white exterior can be seen from miles away! When we finally made it inside the temple, we were treated to a serene and beautiful interior.

Humayun’s Tomb: This monument reminded me of a mini-Taj Mahal! It was situated within a very large complex that also housed certain other buildings. I recommend that you plan a visit to this well-maintained location.

Lodhi Gardens: We were pleasantly surprised by how large Lodhi gardens was. It had at least four large architectural buildings in addition to a beautiful lake and walking path.

India Gate: While leaving Delhi I got to see the India gate by car! This is definitely a location you should try visiting in the evening due to the lighting of the gate in the dark.

Seventh Stop: Chandigarh, Haryana/Punjab

How we got there: A five-hour drive by car.

My final destination in India was Chandigarh which is the capital of both Haryana and Punjab. My entire extended family lives here and I was lucky enough to be in Chandigarh during my last week in India because I got to attended my first ever Indian wedding in India!

My cousin was getting married, so I had the unique opportunity to see a large variety of Indian rituals up close. The wedding was a weeklong event and began with a kirtan which is essentially a puja, or prayer, where lots of musicians and tabla players are invited to sing prayers. I also got to see the mehndi ceremony which is when the bride’s henna is applied. I also got to get my own!

The morning of the wedding, I saw the chooda ceremony which is when the bride adorns the large set of red, bridal bangles given by her maternal uncle. Additionally, she was required to cover the bangles in white cloth and keep her eyes closed during the ceremony because it is considered inauspicious for the bride to see her bangles before the wedding. The same day I participated in the haldi ceremony where a paste of turmeric is applied on the face and arms of both the bride and groom by various family members. This ceremony is considered to be a blessing from the elders that apply the paste.

Chooda bathed in milk before wearing

 At the actual marriage which occurred very late in the night due to the auspicious time selected by the priests, I also saw the wedding rituals which consisted of garland exchanges between the bride and groom and the barat which is essentially the groom’s entrance into the venue. Nearing the end, I got to see the saat phere which is when the bride and groom, tied together by a knot, take seven rounds around the fire to signify their matrimonial bond and vows to one another.

  • Wedding
  • Ring ceremony
  • Ring ceremony
  • Wedding
  • Wedding

Soon after the wedding I partook in Raksha Bandhan which celebrates the brother and sister relationship. Essentially, the sister ties a “Rakhi” on her brother, a decorated bracelet, and later receives a gift from her brother. This celebration and the tying of the rakhi symbolizes protection and love between the siblings.

Just as I was getting to leave India, I also saw the beginnings of the preparation for the 75th Day of Indian Independence. It was amazing seeing tricolors all around the county, especially adorned on autos!

Slow Down (It’s the Cataracts)

Sat, 08/20/2022 - 13:22

As our time in Madurai came to an end, I felt the intense urge to slow down time. Even when walking or eating a meal, I tried to take a breath and appreciate the wonder of my new routine. Slowly and then all at once, my brief time in India became the most transformative and enjoyable summer of my life. Here is my (rather long) attempt to articulate some more details in this experience.

Part 1: The Hospital

At AEH, more than half of operations are completed by 9 AM in the paying OT. This efficiency is impressive given that patients start being admitted at 7. The OT complex is divided into separate rooms for retina, pediatric, glaucoma, cornea, cataract, and orbit surgeries. Out of these, cataract surgeries are the fastest and most likely to have consistently good outcomes. Unoperated cataract is the leading cause of preventable blindness worldwide, and it can only be fixed by surgically extracting the cataract (clouded lens) and implanting an intraocular lens (IOL). So, cataract surgery is estimated to be one of the most commonly performed surgeries in the world. It’s also one of the most cost-effective interventions, with a high economic and mortality benefit. Generally, the cataract OT at AEH Madurai completes anywhere from 70-250 surgeries per day, which really speaks to the efficiency and dedication of the team. Dr. Jebinth Brayan at AEH Coimbatore gave a talk sharing how he is able to perform around 100 cataract surgeries over the course of one day, which makes him a standout among standouts.

Once a patient enters the AEH cataract clinic, the basic steps are to first register the patient and hand them a route card outlining each station. Then, the patient undergoes testing for vision, refraction, blood pressure, and intraocular pressure. Unless a patient has pain or redness, they will undergo dilatation. They will be examined for lacrimal duct patency and scanned with A-scan biometry to determine the IOL power needed. After the doctor examines the patient and gives their opinion, the patient can move onto counseling and an optical shop/medical shop or specialty clinic opinion as needed. After their consultation, patients can return the next day for a day care surgery, meaning that they will return home on the same day and then come back the third day for postoperative review. AEH Pondicherry has streamlined this process even more, so ~30% of patients can return to the hospital less times through more testing at a local center. In the free clinic, almost every single patient screened in the general ophthalmology unit has cataracts. The free patients are mostly elderly and from rural areas, so it’s important to minimize the amount of trips needed to the tertiary hospital.

The payment models at AEH, and especially the affordability, are a key part of what makes the surgeries so accessible. Patient charges for a cataract surgery are broken into four main categories on the bill: surgical spending, theater cost, medicine, and pre and postoperative medicines. Prices can vary based on the type of surgery (MICS or phaco) and the IOL cost. Overall, the total cost for one surgery in the paid hospital averages only a couple hundred dollars. And what if a patient has complications after the surgery? For example, posterior capsule opacification (PCO), often called secondary cataract, is when lens epithelial cells remain and differentiate, causing scar tissue to form behind the IOL. PCO causes blurry vision and glare, similar to a cataract. PCO is the most common delayed postoperative complication of cataract surgery; some studies suggest that PCO occurs in 20%-50% patients within two years after operation. YAG laser capsulotomy is the standard treatment, and it takes only five minutes. Most American providers charge at least $1,000 for the laser itself, not including anesthesia, imaging, and other visit fees. At AEH, YAG cap charges range from 0 rupees to a maximum of 800 rupees ($10) per eye.

Despite the impressive efforts made by AEH in the iron triangle of health care (access, cost, and quality), the cataract department at Aravind is still constantly seeking areas to improve. As Dr. Madhu Shekhar and Dr. Aruna Pai both explained, the issue of second eye surgery completion persists among patients with bilateral cataracts. Barriers to follow up for another surgery may be due to several factors, namely lacking an attender to accompany them, other personal commitments, work commitments, or religious festivals. 

During the celebration of Aadi Perukku on August 3rd, the streets of Madurai were quieter, and there were far less patients in the clinic than usual. After work, Aravind and I headed to Meenakshi Temple, which was filled with devotees and made for a breathtaking experience. Combined with the emptiness of departments as many doctors went to the Tamil Nadu Ophthalmic Association (TNOA) conference, this made our last week at work comparatively quiet and a time full of personal reflection.

  • Principal Scientific Writer at Novartis, Shivani Vadapalli, teaches us to make scientific posters at a grand rounds talk.
  • Sister Tamilarasi uses a digital ruler to investigate a patient in the A-scan biometry department.
  • Dr. Madhu Shekhar examines a cataract patient with a slit lamp.
  • Welcome to the OT! Rooms F and G are designated for cataract surgeries.
  • Surgical monitors in the OT. The left screen shows a small incision cataract surgery (SICS), and the right screen shows a phacoemulsification (phaco) surgery.
  • A vitrectomy in AEH Pondy.

Part 2: Hospitality and Heart

While I expected to see a lot of impressive work in the hospital, I was most touched by the people I met. Ushalini described Madurai as a place where people share “unfiltered love,” and I could not agree more. Happiness in India is simple and abundant, but I comfort myself with the knowledge that this same capacity for joy has been expanded just from the lessons I learned this summer. My favorite memories with the following people who made this happiness so easy are hard to describe in words, but here are my attempts to summarize why I appreciate them so much.

My pillars of support were my project mentors, Ushalini, Ramesh, Yesu, Suresh, and Sr. Selvi, along with Srilakshmi and Dhivya. Beyond being professional role models, they are all friendly and caring people with real passion for their work. Within the cataract clinic, Sr. Selvi, Sr. Kamatchi, Sr. Karthikadevi, and Sr. Mariammal always looked out for me and made every single day a treat. Sr. Selvi and Sr. Mariammal even joked that they wished they could adopt me or have me stay in their houses so I wouldn’t leave. In the OT/sterilization (CSSD) complex, I have to acknowledge the MLOP sisters, including Selsiya, Vidhya, Gayatri, Mounika, Jagadeeshwari, Nivethitha, and Deepika, who are unbelievably energetic and friendly. After being greeted with the sisters asking for my name, native place, and whether I finished my breakfast, they clamored to share more about themselves too. Every time I saw them, I felt overwhelmed with their enthusiasm. Jeyageetha and Kalaivani in the A-scan department, and Jothipandi and Ranjitha in the physician department, were so welcoming and patient with me as I learned the ropes. In short, the sisters are the backbone of AEH, and they’re fun to be around too!

Dharini in the Aurosiksha office taught me so much from her passion for life and her generosity. Her talent at making kolams with rice flour, stringing flower garlands, designing mehndi, making coconut leaf brooms, and cooking delicious South Indian vegan recipes completely blows me away. I will always treasure the hoop earrings she gifted me, and the drawing she gave me with the message “keep smiling.” Next to her in the Aurosiksha office, Atchaya is so kind and funny. Her smile is infectious, and she never fails to brighten my mood! Because we’re not too far apart in age, we can definitely relate on a lot despite our different cultural backgrounds.

The wet lab, which is used to train MLOPs and doctors in surgery, was another source of unexpected friendships. I always enjoyed talking with Mani (wet lab training coordinator) and Abinaya (MLOP sister), which made saying goodbye unbelievably difficult. With every hug shared between me and Abi, more and more tears were flowing. Because Abi is likely leaving AEH after next year, it’s hard to know when we will meet again. For now, we stay in touch with daily emails, and I am certain that we will maintain our friendship.

The wet lab was also where I first met Gunjan, a visiting surgical trainee who lived in the room next to mine at Inspiration. I was shocked that we didn’t meet until late in the summer despite living in room 1 and room 2, but we quickly became close. Our conversations after dinner were always so insightful, and I especially appreciate her love of exploring new places and her positive mindset. With her sense of adventure, we tried Jade Cafe, which was right by the Nilgiris supermarket but somehow always escaped my notice. She also showed us the Inspiration refrigerator (the keys are hidden in a coffee maker!) and the basement of the hostel. Visiting all of these “hidden” spots felt like discovering buried treasures, but (cliché alert) I will treasure our time together the most.

Another hard goodbye was seeing Picard right before he left for Dar es Salaam, where he could finally be reunited with his family after eleven months at AEH. What strikes me the most about Picard is his radiant smile, and how he is adored by literally everyone. As we walked to his preferred fruit store one night, he was stopped by so many locals to chat and ask after his family or how his training was going. He made a very compelling case for visiting Tanzania, and his mindset of hakuna matata (no troubles in Swahili) is one I will not forget. Also at Inspiration, Krishna and I spent a lot of time together, to the point where I now consider him as close as if he were an older brother. Fortunately, he is currently studying in Boston and we’re planning to meet again soon. At LAICO, Lisani became one of my best friends of the internship. Before she left, we hugged over and over again, just trying to hold on to each other for as long as possible. It’s hard to know when we will meet again, but we will definitely stay in touch and be lifelong friends. It’s rare to meet someone as compassionate as her, and I am so grateful we crossed paths.

And of course, I must give the biggest thank you to my fellow CASI interns Aravind, Manya, and Suhaas. Aravind’s knowledge on Tamil Nadu (and the world in general), combined with his mom’s planning help and his skill in Tamil, made every trip unbelievably smooth and fun. I appreciate his forward thinking and how he would always push me to “just try” new things. Despite not knowing Manya before the internship, I came to greatly admire her intellectual curiosity, commitment to her values and her family, and her care for others (including every single stray dog). Manya is always very thoughtful and quick to make you question your thinking, which is really special. Suhaas is everyone’s biggest cheerleader and supporter, and he’s a steady presence of good humor (along with some bad jokes). His ability to challenge his lactose intolerance at every turn despite the doubters (see: Krishna’s surprise at Famous Jigarthanda) is also very commendable.

Just when I thought I was finished saying all of my goodbyes, a moment of serendipity occurred. On my way from Madurai to Hyderabad to Delhi, I met Rinkal, a PG at AEH Tirunelveli who happened to be on both of the flights. We hit it off immediately, and our chance encounter was a gentle reminder that connections to AEH will keep popping up after this summer.

  • Bull repping the red and blue. Seen while we took an auto to Meenakshi Temple during Aadi Perukku.
  • Dharini’s drawing for me and Dharini following her own advice. Keep smiling!
  • Gunjan was sweet enough to surprise us with a chocolate cake on my final night in Inspiration!! The icing says “will miss you.”
  • Camera ate first during my snack break after work with Lisani.
  • Mess hall moments. Krishna is reading the Tamil on the back of my notebook to me and Aravind. Apparently, the translation is “there is no substitute for hard work.”
  • Suhaas, Aravind, Srinath, and I went with the communications team to watch Gulu Gulu on opening night. There were no English subtitles, and the movie’s plot was hard to follow because it’s an absurd dark comedy. This still from the previews was my mood the entire time — confused but amused.

Finally, here are my tips for future CASI interns who have the extraordinary luck of spending a summer at Aravind Eye Hospital.

Plan your project realistically in terms of what you can accomplish each week, but be flexible to changes or delays in your schedule. The slogan “arise, awake, and do not stop until the goal is reached” was a slogan popularized by Swami Vivekananda in the context of breaking free from colonial rule, but the idea holds true at AEH. Come to work every day with a question or task, and keep at it. Almost every night, I would dream about the hospital or my projects in some capacity, so you will really will be consumed (in a good way!) with your work.

Keep two main points of contact — one project guide with a vision of the deliverables and goals, and one subject matter expert in the department — as your go-to people. They will help greatly with arranging meetings with other stakeholders and for providing ongoing guidance. After we chose projects and project guides, I found it most helpful to spend every single day working in their respective hospital office instead of the LAICO office we were given. Swap WhatsApps for constant communication instead of relying on emails as the primary form of communication. Tell everyone involved when you’re doing something. In general, over communication is vital because people are all busy with various tasks and deadlines.

Understand the existing challenges and see the bigger picture of why your project matters. For example, for my training project, I saw its importance because skills improvement leads to more safety and consistency. There’s a lot of room for improvement in optimizing MLOP training, given that MLOPs come with only a basic level of prior knowledge and some resources are inconsistent in quality. Within my time, I could focus on a few specific training areas and pilot them with MLOPs to see if they were effective. My cataract project was also based on the idea that resources already exist at the hospital, but they could be better compiled for practical use by other hospitals. The problem with partner hospital engagements is that lasting change is hard, and it’s easy to regress to square one. Hospitals need to be highly dedicated with a management focus to achieve what AEH can do, and there’s also many adjustments needed for different cultural contexts, different norms in surgical standards, and budget constraints.

Make time for casual conversations, take breaks, and stay hydrated. As Sister Selvi said, after almost 30 years of work, she still gets so engrossed in her tasks that she can forget to take breaks or go home on time. But almost everyone will take coffee and snack breaks for 10-20 minutes — once in the morning and once in the afternoon. The ground floor coffee shop is always popping, and you can learn a lot from talking with people there. Vasantham in the inpatient building is a large canteen frequented by both staff and patients, and they have great food. Beyond that, I was often offered snacks in the office, among which my favorites were Candyman choco double eclairs (think a tootsie roll with liquid chocolate inside), jackfruit, and kamarkat (made of coconut, jaggery, cardamom).

Don’t be too discouraged by language or communication barriers. There’s definitely a learning curve, as you’ll quickly have to understand new medical terms and countless other new concepts you can’t even anticipate. I was initially confused by the comma placement between digits. It took a while to learn that 1 lakh = 1,00,000 = 100,000, so 10 lakh = 10,00,000 = 1 million. Another new term was crore, which is equivalent to 1,00,00,000 or 10,000,000. Some things felt very counterintuitive — restaurants are called hotels, and the ground floor is floor 0. I tried to pick up on other nuances in speech, like adapting the phrases “today evening” or “today morning” and adding “only” for emphasis. I found other new phrases very charming, such as “do the needful” (do what’s necessary), “lady finger” (okra), and “dustbin” (trash can). Probably the most important modification to my speech was honorifics. It’s important to add sir or ma’am after names of your superiors for respect, and to learn the hierarchy of doctors — medical officers (MOs), long-term fellows, and postgraduates (PGs).

Learn as much as you can learn about any areas of interest, like patient education, a specialty clinic, surgery in the OT, patient counseling, community health and outreach, infection control and microbiology, AMRF’s research, or anything else you’re curious about. AEH’s scope of involvement is extremely wide! In the hospital, you can often just walk in and state that you are a project student doing an observation, even if the clinic you’re observing is unrelated to your main projects. Basically any department and personnel will be enthusiastic and totally open to your questions.

Meet with as many people as possible at all levels of seniority and experience, from the Chairman and CMO to the heads of department (HODs) to MLOP trainees and everywhere in between. You will learn so much when you can grasp both the details and the broader vision. You can also seek out other educational opportunities and talks because they will really open your mind. For example, Dr. Karl Golnik from the University of Cincinnati gave an excellent guest grand rounds talk on his tips for neuro-ophthalmology and the importance of proper screening, and many other internationally renowned experts work with AEH.

Get to know the other interns and trainees!! They might become your close friends, or at least provide fresh perspectives. There’s always many projects across different areas, and the interns we met worked on projects including implementation of total quality management, reducing clinic wait times, improving the electronic medical record functionality, financial management, data visualization, customized patient engagement campaigns, logo redesign, and more. Trainees come from diverse backgrounds, and when you live in the hostel, it’s easy to strike conversation in the mess hall or lobby.

Believe that you have unique perspectives to contribute. As Dhivya affirmed, interns help accomplish projects that might be on the back burner or were never even considered. Dr. Venkatesh gave an example of a Belgian project student, who was only there for one week and spoke limited English. Despite this, the student thought of the “simple but brilliant” idea of including monitors at the registration counter in AEH Pondicherry so patients can verify their information more easily. This small change led to a big reduction in transcription errors. You will also make a difference with your work, even if you might feel like a minor piece of the puzzle with only a small amount of time.

Assume the best in people and in outcomes. A big smile and an open, friendly attitude goes a long, long way!! Embrace taking photos for the memories because you will accumulate thousands. My phone’s photo gallery tagged both the hostel and AEH as “home” by the end of the summer, and I know you will feel at home too.

  • The meditation room right next to the cataract clinic.
  • Arise! Awake! And stop not till the goal is reached. Thanks for the message, bus.
  • In the AEH Madurai block room (for anesthesia), a sign says “Performing good surgery & giving vision is like doing yoga. Let us practice this in a quiet way!” Peep the framed portraits of The Mother and Sri Aurobindo.
  • Entering the AEH Pondicherry OT with a worry-free mind. The sign reads “surgery is a serious profession, do not carry your worries beyond this point!!!”
  • Motivation above Dharini’s desk. We had an insightful discussion about how if (external) work cannot be your source of joy, you can still express your (internal) joy through your work.
  • “Much has been done, but much remains to be done…” above several of Dr. V’s awards in the library.

Further Fulfilling my Wanderlust: Travels Through Tamil Nadu (Part 2)

Fri, 08/19/2022 - 17:53

At the end of my last blog post, I had left you when we had just hopped off the train from Coimbatore in Madurai, at the end of our Ooty trip. We actually didn’t have any further trip plans made at this point. Some locations we were thinking of going to next included Munnar, a small town in eastern Kerala famed for its tea plantations, and Mysore, a historic city in southern Karnataka that was the capital of one of the great realms of southern India, the Kingdom of Mysore. While we especially wanted to visit Mysore, a combination of train booking unavailability and the long travel likely inhibiting our project timelines, we were forced to this plan.

That week at Inspiration, we talked more with Krishna, the Aurolab intern I previously mentioned whose father leads AEH-Pondicherry. He mentioned that he was going to Thoothukudi, on the southern coast of Tamil Nadu, with his friends that next weekend. Having heard of Thoothukudi but not knowing much about it, I learned from him that the town is famed for its coral reefs, snorkeling, scuba diving, and other water sports (the Tamil Nadu government has recently started promoting tourism there as well). This also coincidentally being the last district I needed to check off my list in southern Tamil Nadu, we decided to make this our next weekend trip.

Trip 3: Thoothukudi (July 17th)

Thoothukudi (known as Tuticorin to the British colonists) is also popularly called Muthu Nagar in Tamil, meaning Pearl City. One of the most famous aspects of this area’s economy, along with salt production and maritime shipping, is beautiful pearls from marine oysters. Celeste and I extensively planned for this trip since we’d only have a day and there was so much to see—the vlogs and pictures online made us all the more excited. We ultimately made a very detailed and ordered plan for our visit. Unfortunately, Suhaas and Manya weren’t able to join us on this trip because their visits to their respective eye camps were planned for that weekend.

Celeste and I woke up early on Sunday morning in order to make it to our train, the Mysore-Tuticorin Express that would depart Madurai Junction at 7:40 am. We thought it would just be us two, but as a pleasant surprise, my mom had traveled to Madurai from Coimbatore the previous night and would be joining us since she also hadn’t been to Thoothukudi before and also wanted to make sure we got around this unfamiliar place safely.

We arrived quite early at Madurai Junction, so again I had time to satisfy my inner childhood railfan and was able to see a variety of trains coming from all around India. Finally, right on time, the Tuticorin Express arrived and we boarded our train. This time, we had splurged a little bit and booked a 2-tier AC coach, which has two levels of beds rather than three with curtains separating the berths, giving more space and privacy. Still, the ticket was only around 700 rupees (less than 9 dollars), which from a US perspective make me wish travel back home was this affordable!

Most of the passengers were coming from Mysore and had disembarked at Madurai, so the train was not too crowded. We hadn’t slept much the previous night (I was working on another blog post until 4am!) so we slept and gazed out the window at the rolling fields and patchwork of palm trees that characterizes the landscape of southern Tamil Nadu.

We arrived at Tuticorin station quite early, by 10:30 am. The cool sea breeze rustled my hair as soon as I stepped off the train, perfectly complemented by the salty aroma wafting from the ocean and the abundant salt pans nearby. As we exited the station, we found an auto driver who was willing to take us around for the whole day, and we then set off.

Our first stop was the famous Thoothukudi Salt Pans. Capitalizing upon its seaside location, Thoothukudi actually manufactures a significant proportion of all the salt used throughout India—which is quite a lot based on the love of spices and flavoring in Indian cuisine! The auto stopped on the side of the road, and we were able to climb on top of the 15-foot high white glistening salt mounds that stretched as far as the eye could see. We even tasted some to sample—it couldn’t hurt after all right? There was enough to go around!

After some more fun sliding down the salt piles and observing how the salt was made, we then headed off to our next stop, the Tharuvaikulam Beach a bit north of the main town area. The Tamil Nadu government set up a glass bottom boat here to promote ecological tourism, for just 300 rupees per 3 hour ride. Unfortunately, this time of year in mid-summer was not the best for viewing the corals and the ticket office turned us away because the water was just too cloudy to see the reefs.

Still, we enjoyed some time relaxing on Tharuvaikulam Beach with the warm waters of the Indian ocean gently lapping on the unique ribbons of red-orange and white sand along the coast. Despite not being able to ride on the boat, we still climbed aboard to look around and take pictures! As we were dipping our toes in the turquoise-blue waters of the Indian ocean, I thought to myself that this was a stark contrast to the frigid rain of in the mountains of Ooty the previous week and realized just how diverse Tamil Nadu is, despite being just one state out of many in India. Experiencing these contrasts and sampling the lifestyles of people from vastly different settings like these is why I love traveling so much.

After some more time admiring seashells and washed-up coral on the beach and then watching a herd of goats go by, we then headed off to our next destination, one of the most iconic places in Thoothukudi—a historic white and blue church called the Basilica of Our Lady the Snow.

Churches can be found throughout Tamil Nadu because of the state’s geographical position at the southern tip of India being a natural crossroads of historical trade between the West and the East, opening up the doors to external influences like European missionaries. Even today, churches remain quite abundant in the state because of the Tamil Nadu government’s special emphasis on religious tolerance and diversity even more so than many other states in India. Within Tamil Nadu, Christianity is most prevalent in the most southern districts like Kanyakumari, Tirunelveli, and Thoothukudi, since their location made them the most easily accessible to external influence from these missionaries.

Celeste and I had previously marveled at online pictures of this magnificent church, but it was even more beautiful in person. The white stone walls of the church accentuated by blue trim around the doorways and windows with a completely blue ceiling was a more simple elegance that was quite distinct from the plethora of colors and intricate carvings making up the temples in Madurai that we had gotten more used to.

Inside, we spent time marveling at the intricate, colorful art at the altar, combining a decidedly Tamilian art style with traditional Christian representations. It was definitely a stark contrast to any church in the U.S. and we both enjoyed reflecting about how different historical crossroads led to the development of this unique art style and branch of Christianity here in South India. After some more time walking around inside the church and sitting for some quiet contemplation, we then headed out.

The next place we visited was another characteristically-Thoothukudi location, the town’s fishing boat harbor. As you can see in the photos below, these fishing boats were jam-packed together, impossible to get out unless all the ones in front moved. Our auto driver said that these boats were still in use—many go out at night when the fish patterns become more favorable. We even climbed aboard one of these boats and looked around!

Our next stop was the V.O. Chidambaranar Port, the main harbor of Thoothukudi that is the site of its maritime shipping industry. While we weren’t allowed inside because it was a Sunday, we were able to take a look around at some of the exports. I was particularly awestruck by the massive fiberglass wind turbine blades that were almost 200 feet long. We found a small, secluded beach near the port and spent some time there quietly relaxing in the cool sea breeze only accompanied by the sound of rustling palm trees and the gentle waves washing ashore.

Next, we went to Harbor Beach, a favorite amongst both tourists and locals, where we spent some more time wading in the ocean. Another interesting sight here were large sheets on top of which fishermen were spreading small, anchovy-like fish to sundry. It was interesting seeing the process of boats piled high with these fish coming onshore, and then observing as they were set out to dry like this.

Another recommendation from the vlogs we had watched was to visit Thoothukudi Eco Park. We went here next, where we were able to kayak in a saltwater lake near the ocean. We enjoyed boating around for about half an hour, which was a nice bit of relaxation in the otherwise jam-packed day.

After a quick stop at Roche Park, the main town park of Thoothukudi, we then headed to perhaps the main attraction of the town—Muthu Nagar New Beach. Unlike almost all of the other places we went to that day, this beach was quite full with people, so it definitely was not as serene of an experience. Still, it was great to take in the sights, sounds, and scents, from people excitedly swimming amidst the waves to beachside vendors selling delicious snacks and fruit juices. This beach also has the famous I Tuty sign, which we made sure to get a picture with!

Sunset had come upon us and it was already getting dark by now, so we decided on making one final stop before heading back to the train. Aside from the seafood, one of the most famous foods in Thoothukudi are the cashew macarons, invented at Ganesh Bakery in the heart of town. Anyone who visits Thoothukudi raves about these airy, crunchy treats, so we had to go try them for ourselves. We were definitely not disappointed by our sampling, and we bought a couple of boxes to take home.

It was almost time for the train, so we asked the auto driver to take us back to the station. We made one final stop however—to try the famous oil parottas of Thoothukudi. These are like Madurai bun parottas, but they are deep-fried in oil (yes, I was also surprised someone found a way to make the bun parottas even less healthy!). We bought a couple each and then packed them in a parcel to eat at the station.

Our return train, the Pearl City Superfast Express, was already waiting for us at the station when we arrived, so after eating our dinner, we boarded the train, and soon fell fast asleep as we pulled away from Pearl City at 8:30 pm on the way back to Madurai.

We arrived back in Madurai right on time around 11:30 pm, and headed straight back to Inspiration in order to rest up in preparation for our work week ahead.

Trip 4: Chennai (July 22nd to 24th)

I mentioned in my previous post that I had traveled quite extensively throughout Tamil Nadu even prior to this summer. From Coimbatore to Kanyakumari, Trichy to Rameswaram, I had seen and experienced so much. But strangely, I had never been to Chennai!

To most Tamilians, Chennai is not exactly considered a prime vacation place. Yes, it has centuries of history including as the capital of the Madras State and now Tamil Nadu, and has incredible attractions, from historic government buildings like the Madras High Court to places for relaxing like Marina Beach, but there are still so many other places that most Tamilians would consider far more beautiful and worth visiting.

Still, I knew I needed to visit Chennai at least once—how could I say I had fully experienced Tamil Nadu without visiting its capital and largest city?

Thus, Celeste and I decided our next trip would be to Chennai. An added bonus was that we’d be able to stay with my cousin and spend time with him as he took us around the area. Manya and Suhaas decided not to come because both have spent quite some time in Chennai on many ocassions.

We decided to make this trip fairly long as well, since a day trip to Chennai would not be feasible given the travel time. We’d leave on Friday afternoon, reach Chennai by Friday night, and leave Chennai on Sunday night to arrive back in Madurai on Monday morning.

After going to work on Friday morning, Celeste and I took the afternoon off so we could pack and then head to Madurai Junction. Our train to Chennai was the famous Tejas Express, recently introduced as the fastest train in Tamil Nadu and one of the fastest in the country. While most trains take about 9 hours between Madurai and Chennai, the Tejas Express only takes 6. We arrived at Madurai Junction with time to spare for our 3:00 pm departure, so we spent some time walking around and then boarded the train.

Once we boarded, I could see why this train had made so much news. Unlike the sleeper cars with stacked beds we had gotten used to, the Tejas Express’s seats were arranged in a 2-2 configuration, complete with personal TVs, WiFi, a traytable, and luggage storage overhead—it was almost like taking a flight! The experience got even better as they started us serving the food that was included, first an array of afternoon snacks with tea and later a full Indian dinner and desert!

During our train ride, we mostly worked on tasks for our respective projects since we were nearing the end of the internship by this point and there was still much to be done. We quickly sped through the Tamil Nadu countryside, only stopping at Dindigul and Trichy along the way.

At around 8:45 pm, we began seeing the bright lights and bustle of Chennai outside the window, and soon pulled into Chennai Egmore station. We initially thought we’d have to find an auto or ride the Chennai metro to my cousin’s home, but he very kindly came to Egmore station to pick us up.

After a 45-minute auto ride through Chennai, we eventually made it to my cousin’s apartment, where we talked with him and his wife for some time and then headed to bed.

The next morning, we awoke early in order to have enough time for everything we planned. The main attraction today would be Mahabalipuram, the site of an ancient city 1 hour south of Chennai whose stone structures and intricate statues are still standing today.

After getting ready and esating a breakfast of idly, vada, pongal, sambar, chutney, and pineapple kesari, we headed out. My cousin booked a driver for us to have the whole day, which made getting around very easy.

Our first stop was the SIMS Hospital, a private hospital in Chennai especially famed for its neurological and neurosurgical treatment. My uncle is the Chief of Radiology there, and I wanted to make a quick visit to meet him since it had been a long time since we’d last met. Once there, he very kindly took time out of his day to take us on a tour around the department and explain his work to us. We spent quite some time talking to him about our internship so far at Aravind as well, and learned about the operational differences between a nonprofit like AEH and a for-profit private hospital like SIMS.

After our visit, we then headed for Mahabalipuram. After a slow crawl through the Chennai weekend traffic and seeing some famous sites along the way like IIT Madras and the 44th Chess Olympiad being set up, we finally made it to Mahabalipuram around 1:00 pm.

Unfortunately, we encountered another obstacle. While my entry fee was only 50 rupees since I could pass as an Indian national, Celeste’s ticket cost 650 rupees! This was just one of many pricing discrepancies between foreigners and locals we encountered throughout the summer.

After we entered, we spent a few hours exploring the rock formations, caves, and ancient stone temples around Mahabalipuram. The scorching sun bared down upon us, but it was still all worth it to see this amazing place. My favorite part of Mahabalipuram was the so-called Krishna’s butter ball, a perfectly spherical rock that is on a sloped stone hill but is stuck in one place and has not rolled down. We had fun taking lots of creative pictures here and also spent some time snacking on juice and ice cream in the much-welcome shade.

After this area, we then headed to the Five Rathas, another site a few kilometers away that also had several ancient stone temples and sculptures. While this site was much less expansive than the main area of Mahabalipuram, we still had fun climbing into the temples and exploring them, admiring the intricate carvings on the columns and walls and taking pictures with the sculptures.

We were quite famished by now, so we decided to get lunch at a small local restaurant along the beach road. The coastal areas around Chennai are known for their delicious seafood, so we took the opportunity to try local preparations of fish and squid.

Our next stop was Besant Nagar beach. Despite the fact that we had left our lunch place in mid-afternoon, we got stuck in Chennai traffic again and it was dark by the time we reached the beach. Besant Nagar Beach is a favorite amongst locals for being more serene and peaceful than Marina Beach, so we still wanted to go and experience it. The night beach experience is definitely something I would try again. While we couldn’t see much, it was quite calming to feel the sea breeze and wade in the ocean waves amidst the dark of night. The beach was also much more lively than we expected, with a bustling fish market along the road and vendors selling snacks, toys, and souvenirs.

While we didn’t want to leave, it was getting late, so we strolled through the sand back to the main road. Before heading back to our car, however, we wanted to check out the nearby Shri Ashtalakshmi Temple, a beachside temple famous in Besant Nagar. We walked through several winding streets and alleyways, but by the time we reached the temple, it was closed. Instead, we spent some time on the nearby beach. On the way back to our car, we also stopped at the Annai Velankanni Shrine, a Gothic-style Catholic basilica that is also iconic to Besant Nagar.

It was quite late by now and it had started raining, so we decided to make a quick run for the car and soon started heading back home.

The next morning, we awoke early again in order to take full advantage of our last day in Chennai. The plan today was to explore the main urban areas of Chennai, taking the famous Chennai Metro as transport.

We first took a cab to the nearest metro station, Koyambedu. I was immediately taken aback by how advanced this metro was as soon as we entered the station. The station was very large and clean, with electronic entry gates and even security lines like an airport. I was also very impressed by the train once we boarded—it was even better than the NYC subway and no comparison at all to SEPTA in Philly. Definitely a stark contrast to other trains we’d taken in India, it seemed like the Tamil Nadu government’s investments into public transit in Chennai were paying off.

After disembarking at Chennai Egmore station, we took an auto to the Government Museum and National Art Gallery. These are part of a complex of several museums in downtown Chennai showcasing artifacts and art of the history of Tamil Nadu and India from ancient times to early-modern history. We spent a couple of hours here learning about the stories that these exhibitions told and even got to learn about Indian contemporary art when we visited the National Art Gallery.

Next, we headed to Fort St. George, the site of the Tamil Nadu Legislative Assembly and other state government buildings. On the way, we drove over the Napier Bridge, which was decorated completely in a chess theme, complete with black and white checkers and different chess pieces, commemorating the upcoming 44th Chess Olympiad. We visited the Fort Museum, where we were able to learn more about the history of Tamil Nadu, particularly about the period of British colonial rule and their ongoing influences on government and society in Chennai to this day.

On the way back, we briefly stopped at the Madras High Court and drove by the Reserve Bank of India, two other places we wanted to see in Chennai.

We then headed to Marina Beach, where we first stopped to eat a traditional seafood lunch prepared at a small beachside stall. After sampling a variety of delicious fish, prawns, and squid, we then headed out to the water. This took longer than we thought, however. Marina Beach not only the second longest in the world, but also deceptively deep—the sand stretches for about a quarter kilometer from the beach road to the ocean.

We eventually made it to the water, where we set up our beach towels in the five feet of available space we could find amidst the bustling Sunday afternoon crowd, and started wading in. We spent several hours here just talking and walking along the sand, and taking in the sea breeze from the Bay of Bengal.

The sun eventually started to set, and it was time to leave so we could cover the remaining items on our list before heading to the train station. We hailed an auto and then drove along the Marina Beach road, where we briefly stopped to take a picture with the “Namma (Our) Chennai” sign and then at the St. George’s Church.

It had gotten dark by now, and the time of our train’s departure was approaching, so we ate a quick dinner across the street from Chennai Egmore station and then headed for our train. We said our goodbyes to my cousin and his wife, and then headed in to wait for our train.

However, it was only 7:45 pm by this point, and our train was only scheduled for 10:00 pm. We didn’t want to spend our last couple of hours in Chennai just waiting at Egmore station, so we took the impromptu decision to get back on the Chennai metro to just ride around the city. Earlier that morning, we had only ridden a few stops on one line, so we decided to explore the rest by riding the other line and making a circle around Chennai. We were able to take in several beautiful night vistas of different Chennai neighborhoods from some of the above-ground metro stations, and made it back to Egmore with plenty of time to spare.

Back at Egmore station, we easily found our train platform and boarded our train, the Madurai Mahal Express. In contrast our inbound train, the Tejas Express, this train would take significantly longer to reach Madurai, more than 10 hours. We would be taking a more indirect route, first along the coast and then turning westward toward Madurai, passing through the eastern cities Cuddalore, Mayiladuthurai, Thanjavur, and then only re-connect with the main route at Trichy. Still, we would be sleeping most of the way and we were scheduled to reach Madurai at 8:15 am the next morning, so this wasn’t much of a problem.

We fell fast asleep soon after boarding the train, and awoke as we were passing the Sirumalai mountain range in between Dindigul and Madurai. Right on time, we reached Madurai Junction as the bright Monday morning sun shined overhead. We disembarked and took an auto back to Inspiration to get ready for work, with our penultimate trip and last train journey this trip completed.

Trip 5: Pondicherry (July 29th to August 1st)

One of the most popular trips for past CASI interns and even other interns at Aravind has been to Pondicherry. AEH-Pondicherry likes to have the intern group there to give them a tour of that hospital and explain how they’ve implemented the decades of learnings from AEH-Madurai as they were developing this hospital. We were also excited to have Pondy as our last trip, not only to explore AEH-Pondicherry and meet the much-storied Dr. Venkatesh (CMO of AEH-Pondicherry and father of Krishna, our fellow intern and new friend), but also to experience the unique French-Indian amalgamation that is Pondicherry.

Pondicherry is one of four locations in the Union Territory of Puducherry—the other three are Karaikal (also an enclave of Tamil Nadu), Mahé (an enclave of Kerala), and Yanam (an enclave of Andhra Pradesh). Unlike the vast majority of India, Puducherry is a collection of past French colonies, the influence of which remains in the architecture, food, and even language today.

An added bonus on this trip was that Sylvia would be joining us! This was quite a last-minute addition—I was coordinating with Sylvia the morning of our trip to get bus tickets—but I’m glad that everything worked out for her to join us.

We left Madurai at 11:15 pm Friday night after boarding the Vaigai Travels sleeper bus that would take us overnight to Pondicherry, dropping us off right at AEH-Pondicherry at 5:30 am the next morning. Like our previous sleeper bus to Coimbatore, this bus was also very comfortable, and after working a bit on our projects, we climbed into our bunks and fell asleep.

I awoke in the middle of the night when the bus paused for a rest stop on the outskirts of Trichy at around 1:00 am. We all hopped of the bus to stretch and buy some snacks at the roadside stand—we shared a delicious sweet coconut bun which definitely hit the spot. We all fell asleep soon after the bus departed, and the hours rolled by until the morning.

A golden ray of sunlight passing through the window disrupted my slumber, and I awoke to see a golden orb rising up from the horizon. My heart sank a little because we had planned to head to Rock Beach to see the sunrise—it turned out the bus was running late.

We only reached AEH-Pondicherry by 6:00 am, and after some time figuring out where the guest house was and then how to get in, we were finally welcomed in by one of the sisters.

To put it simply, the guest house was amazing! Rather than the quite large, hotel-style layout of Inspiration, the AEH-Pondy guest house was quite similar to a large mansion, with a foyer, living room, dining room, kitchen, central courtyard with lush green plants, and bedrooms arranged in a square on the floor above. We wished we had planned for some more time here!

Since we had already missed the sunrise, we took a couple of hours to nap and freshen up, with the plan to eat breakfast and leave around mid-morning. After I napped for a bit and took a much appreciated hot shower, I got ready and headed downstairs.

We all at a delicious breakfast of poori and masala, idly, vada, sambar, and chutney sitting around the dining table together. Meanwhile, we planned our day ahead. We definitely wanted to visit Auroville first. This is a community of people who follow the spiritual teachings of Shri Aurobindo, a philosopher, scholar, and Indian freedom fighter who lived from the late-1800s to mid-1900s. Auroville is a unique society where the economy is said to be all based on bartering and people spend their lives living a peaceful, spiritual existence. Auroville is perhaps the most iconic place to visit in Pondicherry.

We booked a cab online and then headed out to Auroville first. After driving through the streets of Pondy, we got there after not long, and then walked to the visitors’ center. There was a small museum here where we were able to learn about the history and current society of Auroville. Two of my favorite topics to learn about were the development of the barter economy system and Auroville’s efforts with improving primary healthcare. Still, I had some doubts. Is this bubble within the rest of India as idealistic as they made it seem? Realistically, wasn’t this place’s economy supported by tourism dollars and not entirely off the barter system?

Eager to learn more, we headed in, setting off first for the main attraction of Auroville. At the center of this community is a golden orb-shaped temple called the Matrimandir. The main gatherings of this society are held here, and inside is a quiet space for meditation and prayer. We were able to walk the main path to this place, a sandy path through lush green forests and flower-filled fields. Along the way, there were signs displaying the meanings of each different plant and lower according to the teachings in Auroville. After we walked past a lush green garden with perfectly sculpted topiary, a ray of golden light pierced through the foliage—we had arrived at the Matrimandir.

This temple was as grand as I had imagined it—and clearly other tourists thought the same as well. We sat here for a while and took pictures as well. It was also very interesting to talk with the other tourists. One that I still remember is Armand, a current mechanical engineering college student in France who is ethnically Indian and was born in Pondicherry but moved to France when he was 1. His entire family had come to Pondicherry for their summer holidays.

We then returned back to the main visitors’ center after a while, taking the same stroll through the lush, green forest. After we got back, we decided to take a snack break and try the various cafés there. We sampled flower juice, some esoteric ice cream flavors including chai and Auroville-grown spirulina-banana.

While we were here, Manya struck up a conversation with a kind elderly man, who lived in a village near Auroville and came here often. He very generously gave us snacks and then offered to arrange us an “insider” tour of Auroville, where we’d be able to go to places that visitors normally cannot see. He called up his auto driver friend, and somehow all 5 of us managed to squeeze inside.

We thoroughly explored Auroville in this auto, visiting a variety of places including an instrument-making workshop and store, a spirulina farm, a movie theater, and even some of the living quarters of Aurovilleans, which consisted of small apartments. I was most surprised to see that Auroville has a co-working space that would not be out of place in downtown Philly! I initially imagined Aurovilleans to be living lives free of most creature comforts, but this tour shattered my preconceived notions.

Once we were done exploring Auroville, we asked the same auto driver to take us to White Town, the historic French district of Pondicherry. We were excited to try out the French cafés here, but most had extremely long wait times due to all of the summer tourists. Eventually, we were able to find a place in the Hope Café, an eclectic French bistro. It was quite a change eating European-style food after months of eating homecooked Indian meals—I think I still preferred the comfort food of Madurai!

After lunch, we split up as a group, with Manya, Suhaas, and Sylvia heading back to the guest house to rest for a while and Celeste and I staying in White Town.

First, we went to Rock Beach since this is one of the main attractions of Pondy’s White Town. After visiting so many beaches this summer, I still had not swum at any of them, so I took this chance to change into my swim clothes and venture out deeper into the ocean for a bit. Celeste very kindly watched my things onshore while I went out for my swim.

It started getting dark after a while, the red-orange wisps of the sunset painting the evening sky, so we decided to finish off at the beach and head out. The others had still not returned yet, so we took the opportunity to explore more of White Town before they joined us for dinner. First, we went to the Romain Rolland Library, the oldest library in Pondicherry. This library was not too different from libraries back home, but it was interesting being able to browse through some Tamil books as well. I picked up a book on Indian foreign policy, which I read for a while until the library closed at 8:00 pm.

Since we were still waiting for the others, we then headed to another café for some snacks (and to charge my phone!). We went to the pondybucks cafe, where I had a refreshing lemon iced tea and Celeste had a green tea with honey.

When we checked in with the others, it seemed that Manya and Sylvia had woken up, but they were still struggling to wake up Suhaas. In the mean time, Celeste and I took the opportunity to find a nice place to eat. After shortlisting some French cafés online, we then ventured out into the night to walk around White Town to these places. We walked for quite a while, having fun just exploring the streets of coastal Pondicherry which were almost indistinguishable in some parts from those of southern France. Along the way, we walked by the Shri Aurobindo Ashram (which we’d visit the next day) and the Arulmigu Manakula Vinayagar Temple, where we were greeted with the site of an elephant procession.

After walking by the Consulate General of France, an French International School, and some other sites, we eventually made it to the first restaurant on our list. Unfortunately, it was already past 9:30 pm by this point so the place was closing and couldn’t accomodate us. Still, the chef, Chef Stalin, personally came out and suggested us to visit his friend’s restaurant, on a hotel rooftop nearby.

We walked there and certainly were not disappointed. The hotel itself was quite nice, and the rooftop restaurant was all the more better. It had incredible views of White Town, Rock Beach, and the lighthouse, and even had an infinity edge swimming pool. Celeste and I sat down at our table near the pool, ordered food, and then waited for the others to arrive.

Manya, Suhaas, and Sylvia joined us after not too long, and we ate a delicious dinner of various European-style dishes. We took our time to slowly eat our dinner and enjoy the expansive views, and headed back to our hotel after some more late-night exploration of Pondy.

We woke up late the next morning and planned our day over breakfast at the guest house. Our first stop was Baker Street, perhaps the most iconic French bakery in Pondicherry. This place was quite busy, but we eventually were able to buy a few different French pastries and shared it amongst ourselves. We also made another new friend at Baker Street! Charlotte, a French yoga teacher who had come to Chennai to learn Carnatic music was visiting Pondy for the weekend and had been sitting at a table nearby. We invited her to eat with us and soon struck up a conversation, learning about each other’s backgrounds and experiences in India.

After this, we went back to Rock Beach where we walked along the beach road for a while. We decided to split up again, since Manya and Sylvia were interested in doing some shopping while Suhaas, Celeste, and I wanted to explore more places around Pondy. After walking around for a bit, we first visited the Kuthba Mosque, a historic mosque that was build in the 19th century as the first mosque in Pondicherry. The mosque was quite empty when we walked in, but we met the Imam, who kindly took us into his office and started explaining about the history of this place and his family’s contributions. After this, we walked to Sacred Heart Square, where we visited one of Pondy’s most famous Catholic churches. We spent some time here admiring the artwork on the ceilings, looking at the stained glass, and sitting in quiet contemplation.

After we headed out, we next wanted to head to the Shri Aurobindo Ashram. Manya and Sylvia, as well as Charlotte, would meet us there. This ashram was probably my favorite part of the entire Pondy trip. It was very peaceful inside, with beautiful plants and flowers in the ashram courtyard as well that created a meditative atmosphere. We all spent some time meditating here, and also went to the bookstore to read a bit about Shri Aurobindo and the history of this place. My experience and what I learned made me realize why Shri Aurobindo was such a powerful philosopher and why so many followers have grown to love his teachings. I also reflected on how Shri Aurobindo has impacted the development of the Aravind Eye Care System, from influencing its name to its philosophy of selfless service to all of humanity.

We eventually headed out, and were all quite hungry by this time, so we searched for another café to visit. Ultimately, we decided on one called Bread & Chocolate, located on the rooftop of a teal-green former villa. Our group of 6 ate an amazing smorgasbord of different dishes here, from quinoa bowls with fruits and nuts and delicious pancakes to vegetable wraps and a poached egg toast.

After we finished eating, we headed back out—Manya and Sylvia returned back to the guest house to rest for a bit while Charlotte, Suhaas, Celeste, and I headed back to Rock Beach. Suhaas and I went to wade in the water for a while. Once we reunited with Celeste and Charlotte, Suhaas decided to split up to explore White Town on his own, while Charlotte kindly took Celeste and I to the rooftop of her hostel. On the way, we walked alongside the boardwalk of Rock Beach, where we saw bustling shops set up for Independence Day celebrations and a French memorial.

Once we made it to Charlotte’s hostel, we went to the rooftop together, where we talked for quite some time about Charlotte’s experiences back home in France, what she is doing in India currently, and our own experiences as well with our internship. The warm ocean breeze and crescent moon overhead created the perfect atmosphere. It soon got late, and after having juice with Charlotte at the ground floor level, Celeste and I said our goodbyes and headed out to meet Suhaas, Manya, and Sylvia at the Writer’s Café.

Our final stop of the night was a rooftop restaurant where we serendipitously happened to meet a group of medical residents that was also previously at Bread & Chocolate. After spending some time here, we finally took an auto back to the guest house since we had a tour of AEH-Pondy scheduled at 8:00 am the next day.

We woke up early the next morning in order to get ready in time for our tour. After a quick breakfast, we headed to the hospital for a meeting with Dr. Venkatesh, the aforementioned CMO of the hospital. When we got there, the conference room was empty, so we walked around the outpatient building for some time until he arrived. Once he arrived, we each explained our projects to him and he gave his feedback as well as additional ideas to implement. In relation to my project, he mentioned how the neuro-ophthalmology team at AEH-Pondy had designed a research study to examine the best counseling strategies to increase treatment adherence for high risk retina disease patients. He suggested meeting Dr. Manavi, who designed this study, which I planned to do later that day.

After discussing our projects, he then took us on a tour of the hospital. AEH-Pondy had many similarities to AEH-Madurai of course, but there were numerous improvements that I was impressed by. In fact, some of these, like a computer screen displaying billing info to patients at payment counters, were studied and implemented by past interns! Another cool implementation were color-coded footsteps directing patients to each department. This eliminated the need for patient guides that need to be assigned to each and every patient in AEH-Madurai. Dr. Venkatesh’s extremely detail-oriented passion for making this hospital run as efficiently as possible was apparent throughout this tour—he was telling us how he finds ideas everywhere he goes, from optimal chair arrangements in airport waiting areas to ticket systems for customers at ice cream parlors.

Once our tour was over, we split up to do work related to our respective projects. I went to meet Dr. Manavi, who explained how she designed her research study and gave me inputs for my project.

After we all met up again, we were then given the chance to see the operating theatre. After heading up to the OT floor and changing into scrubs, we were taken around to see various OTs. Since this was a Monday, the majority of operations were for eye camp patients, so were mostly cataract removal and IOL implantation surgeries. We were also able to see some retina operations in the retina OT. We were also able to see the pre-op and post-op rooms, where we met Prabhu, a medical resident who we later learned is the son of the head of Aurolab—to us, the family web at AEH seemed to grow more connections day by day!

We left the hospital around 1:00 pm to go back to the guest house for lunch. Celeste had a presentation coming up to pilot her project, but the rest of us to a couple of hours to rest.

Once we woke up, we decided to head back to the beach. We left the guest house around 5:00 pm, eager to go on the nearby river boat to Paradise Beach. Unfortunately, the boating had closed by the time we got there, so the auto driver offered to take us to Eden Beach instead. We drove through a small village to reach the beach, but were pleasantly surprised once we got there. This beach was perfectly picturesque. There was a river leading to the ocean, grove of palm trees around a lake in front of the beach, and then a path to the ocean. We were only able to spend some time near the water since the beach was closing as the sun was setting, so we instead went to the nearby lake. We were able to spend quite a while amidst the grove of palm trees, watching the sun paint crimson, orange, and yellow shades on the crystal-clear water. We had to leave once it got dark, so we got an auto to our final stop.

Celeste had arranged a dinner with Dharshini, the younger sister of Krishna who I previously mentioned. We went to the Cafe-in, where we ate various French dishes and learned more about Dharshini’s life as a medical student in Pondicherry. It was getting quite late, with less than an hour until our overnight bus back, so we eventually had to wrap up and head out.

Our bus was at 10:15 pm and we only got back to the guest house at 9:40 pm, so the sister there was anxiously waiting for us, emphasizing that we’d miss our bus unless we packed extremely quickly. We all hurriedly packed and were out the door by 10:00, speedwalking to the main road in order to catch our bus.

The bus was actually somewhat late in arriving, but we eventually got onboard, climbed into our bunks, and quickly fell asleep as the bus drove through the night towards Madurai. The bus again was comfortable, and we were back in Madurai in no time, reaching the Mattuthavani Bus Stand before 5:00 am. Celeste, Suhaas, and Manya took an auto back to Inspiration and I went with Sylvia in another auto to first drop her off at her place and then headed to Inspiration myself as well.

This trip seemed to go by even quicker than the previous ones, despite being the longest! It was now Tuesday morning, with only four more days until the end of our internship—everything was ending faster than I had hoped, but I was still content knowing we had experienced so many adventures this month.

I headed up to my room, unpacked my bags, and quickly fell asleep, knowing I’d have to wake up in just a couple of hours to get back to work on the final stages of my project.

Branching out from the Temple City: Travels through Tamil Nadu (Part 1)

Wed, 08/17/2022 - 19:42

One of the most gratifying aspects of being in India this summer has been the freedom to travel around and explore places that I wouldn’t have otherwise seen were it not for this internship. Travel has always been one of my greatest passions—I’m the type of person who likes traveling to the most obscure and uncharted places possible just to see how people in such different places from my home live their own daily lives. You could put it this way: while many people have motion sickness, I often say I have “static sickness”.

Having been to Tamil Nadu several times before, several weeks at a time, I had already ticked off some of the more popular places off my list: Rameswaram, Kanyakumari, Trichy, Thanjavur, Coimbatore, and several others. Geographically, Tamil Nadu is divided into smaller regions called districts, of which there are currently 38. Each of these districts has a completely different way of life, things to see, and cultural customs. While all are united by a common Tamil language, one cannot experience Tamil Nadu to the fullest unless they’ve seen all of these districts. You thought India was complicated enough with all of its different states, didn’t you? Having already visited about 20 through previous trips, I made it the goal of this summer’s travels to visit as many of the remaining districts as I could.

Initially, progress on this goal was slow. During the month of June, we were hesitant to ask for days off since our projects were just starting and we were still getting used to the workflow at Aravind. We primarily spent these June weekends exploring different local sites, from the Meenakshi Amman Temple to local restaurants—this ended up being fortunate, because we otherwise wouldn’t have been able to fully explore a city as bustling and diverse as Madurai.

Now, I’ll take you through each of the trips we took during our summer, taking place during each weekend in July.

Trip 1: Kutralam Waterfalls (July 2nd)

When Celeste said that her 20th birthday was coming up during the first Saturday in July, on June 2nd, we knew we had to make our first trip to celebrate. As we were thinking of places to go, I suggested the Kutrallam Falls, in a mountainous area in southwestern Tamil Nadu on the border with Kerala. These falls are famous throughout the state and even India as a whole both because of their natural beauty and religious significance—these falls are believed to be an abode of the Hindu god Shiva and are therefore a famous pilgrimage site for worshippers.

Since we decided on this being a day trip, our journey started early in the morning on July 2nd. We booked the Pothigai Superfast Express, which departed from Madurai Junction at 4:25 am and would arrive at Tenkasi Junction, near the falls, at around 7:30 am. We left the Inspiration hostel by 3:15 to have enough time to figure out the station. We were able to find our platform and boarded the train, which arrived on time. We booked a 3-tier AC coach, so we comfortably slept for a few hours until the morning.

I awoke at around 6 am just as the train was crossing some small towns on the edge of the Western Ghats. This train route is famed for being one of the most beautiful in South India, and my experience definitely did not disappoint—the mountains, farm fields, lush palm trees, and several peacocks were perfectly lit in the golden sunrise.

After arriving at Tenkasi Junction, we initially couldn’t find our driver—only after several phone calls were we able to decide on a common meeting location. As was true on later trips as well, speaking Tamil made interactions like this infinitely easier.

We first had breakfast at a restaurant called Drizzle’s in the nearby town of Sengottai, recommended by our driver. I wasn’t expecting anything particularly out of the ordinary here, but the masala dosa I had was honestly one of the best I’ve ever eaten. Something about the blend of coconut in the potatoes with the perfectly roasted dosa was amazing.

After eating, we then set out on our quest to bathe in the waterfalls. My mom had suggested to first visit the Palaruvi Falls across the border in Kerala. After driving up windy mountain roads, seeing monkeys up close along the road, and taking in amazing views of the lush, forested valley below, we finally reached Palaruvi. I was initially nervous about whether I needed to speak Malayalam in order to buy tickets, but luckily they understood Tamil just fine. We then climbed aboard a small bus that took us up the mountain to the falls. The Palaruvi falls were amazing! There were so many monkeys climbing on the trees around us, and there was a lively atmosphere of people swimming and bathing in the small swimming hole at the bottom of the falls.

After Palaruvi, we then headed back to Tamil Nadu for our next falls, the Five Falls. These are a set of five relatively small waterfalls, which are the second-most famous amongst the Kutralam Falls. Unlike Palaruvi, these falls were divided into different sections for men and women, so Suhaas and I went on one side while Celeste went on the other. As is often true when many men are in an enclosed space, there was much shoving and pushing on our side as people jostled to get up close to the falls. In contrast, from what I could see, the women’s side was much more peaceful, as people were taking turns and even helping each other reach the falls. One drawback with these falls was that there was not much space for swimming, as the water at the base of the falls was only a few inches deep.

After finishing, we dried ourselves off and went to explore the bustling street market near the falls. By this point, all the swimming had made us quite peckish, so we bought snacks like spiral fried potatoes with a spicy sauce and noongu, the coconut-like tasting fruit from palm trees that is a favorite for Tamilians.

Our next stop after this was lunch. My project guide had suggested me to visit the Border Parotta Kadai, a local shop famed for its flaky, delicious parottas. Unfortunately, I guess many others had the same idea, because when we stepped inside, there was not a single space to sit (or stand, even!). We therefore decided to go back to Drizzle’s and had a nice lunch of biryani and different fruit juices.

When we finished eating, our driver then took us to Main Falls, the most famous of the Kutralam Falls. Remember the pushing and shoving I mentioned in the men’s section previously? Well this time, this was amplified 10 times. Again, there was no space to swim at the bottom of these falls, but instead there was just a narrow slippery pathway between the falls and a hard rock barrier a couple of feet away. Because these are the most sacred of the falls, there was an even greater excitement amongst the people to stand under the water. I was actually afraid of being suffocated in the crowd of people, so I thought of backing out. Still, Suhaas and I managed to squeeze through and we found a spot under the water. Up close, I was able to admire the intricate rock carvings behind the water. There were hundreds of detailed carvings of symbols related to the god Shiva, particularly of the Shiva lingam.

We spent quite some time in these falls, but we finally came out and returned back to our car. It was getting late, so we decided to make just one final stop—the Old Kutralam Falls. This waterfall used to be the main gathering place for religious pilgrims before Main Falls became more popular. Our driver parked the car at the base of a small mountain, and said we’d have to trek up 1 kilometer in order to reach the falls. Luckily, the sunny, windy weather was great so we decided to go for it.

Old Kutralam was amazing as well. Smaller than the others but with its own charm and certainly a more peaceful crowd on both sides, we were able to spend time bathing in these falls. The way the golden sunlight reflected through the water and cast the mountainside in a yellow-orange hue was also really beautiful, and we spent some time just walking around here taking in the natural scenery. After walking back down and stopping at some small ancient shrines along the way, we made it back to our car.

As much as we didn’t want to leave, our returning train would leave at 6:30 pm and we were quite a distance away from Tenkasi, so we decided to head back to the train station. However, we saw another falls on the way back, Tiger Falls, so we decided to visit that one before leaving. Tiger Falls was definitely more family-friendly and less intimidating, so we enjoyed closing off on this more relaxed note. Finally, we headed back to the car and dried off.

We then started heading to Tenkasi Junction (for good this time!), and reached back with time to spare. Our return train, also the Pothigai Superfast Express, arrived on time, and after sleeping for most of the way, we arrived back in Madurai around 9:45 pm.

Before heading back to Inspiration, we made one final stop, the Cinesuvai Restaurant for Celeste’s birthday dinner. This place was unlike any I’ve ever been to, with its decor all from movies, from an actual railcar for Chennai Express to a pink Volkswagen Beetle. After a delicious meal and ice cream afterwards, we finally headed back to Inspiration, satisfied that our first Tamil Nadu adventure was successfully complete.

Trip 2: Ooty (July 8th to 10th)

When the British colonized and ruled over India, many could not bear the hot climate, so they sought refuge in cooler, higher locations known as hill stations. Hill stations exist in many countries, but they are most abundant in India, particularly in mountainous regions like the Eastern and Western Ghats and the foothills of the Himalayas. The British set up their vacation spots in these mountain towns, one of which is Udhagamandalam (or Ooty, to meet the pronunciation abilities of the Brits), in The Nilgiris district of Tamil Nadu. Ooty was a prized possession of the British colonists and became to be known as the “Queen of Hill Stations”, because of its picturesque scenery that is viewed by many as even better than other hill stations.

We knew Ooty needed to be on our list of travels since it’s such an iconic location in Tamil Nadu.

We decided to make this a relatively long trip, two nights in all, because it is quite far from Madurai and we wanted to have enough time to fully experience Ooty. We left Madurai at 3 pm on Friday afternoon on a sleeper bus that would take us to Coimbatore. I was initially hesitant of taking a bus for a 6-hour journey like this, but I was extremely pleasantly surprised—it was very comfortable and even more luxurious than the sleeper train from the previous week. The bus was arranged in two levels with single beds on one side and double beds on the other. We all slept for a couple hours and woke up when the bus stopped for a break. After buying some murukku and chai at the roadside stall, we then got back onboard and decided to relocate to one of the double beds to talk and take in the mountainous scenery on this route from Madurai to Coimbatore.

We reached Coimbatore around 9 pm and then took an auto to my grandparents’ house where we’d be spending the night. We had a dinner of several different dishes, from idiyappam (rice noodles) with kurma and coconut milk to kuzhi paniyaram (small balls made of a batter similar to dosa), and talked with my grandparents and uncle as well who had come to visit.

The next morning, we woke up at the break of dawn in order to make it to our ride that would take us up the mountain to Ooty. Perhaps the most famous train in India is the steam train that runs from Mettupalayam, at the base of the Western Ghats, up the mountain to the hill stations of Coonoor and Ooty. This train is operated by the Nilgiri Mountain Railway, so world-renowned that it is recognized by UNESCO as a World Heritage Site. Seeing this quaint steam train that has basically been unchanged since the mid-1910s definitely excited the childhood railfan in me, and I took lots of pictures in and around the train before we left.

Despite the journey being only 46 kilometers from beginning to end, it takes about 5 hours. This is in large part because the track is so steep—with a maximum gradient of 8.33%, it is the steepest railway track in the entirety of Asia. In fact, this train uses a rack-and-pinion system along with its traditional traction from the wheels in order to avoid slipping down the mountain.

While we were initially reluctant at having to spend this much time enclosed inside a small wooden train car, time quickly melted away as we took in the breathtaking scenery while the train wound up the side of the mountain. As the train chugged through colorful small towns, over sparkling streams, by majestic waterfalls, and near magical tea plantations and lush green conifer forests with steam wafting overhead, it started feeling more like a Disneyland ride rather than any other train I’ve been on.

Unfortunately, the journey did have to come to an end, and we eventually reached the Udhagamandalam station right on time. The weather outside was certainly a surprise. I knew it would be cold, but the temperature was actually downright frigid. The freezing rain coming down only amplified this. Nevertheless, it was a welcome change from Madurai weather. In fact, the weather felt more suited for London—I can see why the British liked this place.

Our first adventure was going to a safari park in order to see the local wildlife, from lemurs and peacocks to tigers. We first had to drive there, though. The route took almost 2 hours from the Ooty train station, as we slowly went up and down the mountain roads with countless hairpin bends made all the more slippery by the rain. We finally made it there, but dusk was quickly falling. Despite this, the safari jeep driver agreed us to take us in, and we climbed aboard the jeep to start our tour.

Wind whipping through our hair, we sped along the gravel path through the forest, spotting animals along the way. Highlights included some of the largest peacocks I’ve ever seen, cute Vervet monkeys, very large deer called Sambar, and an abundance of elephants. We even stopped in front of a small historic chapel along the banks of the Moyar River. The tigers proved elusive though, and because dusk was falling, we had to start heading back out.

Before we drove back to town however, we had one final stop—a small mountain from which we could see the valley with the town of Udhagamandalam below. We were intending to drive up in the jeep, but the mud was just too deep—we had to get out and walk. It was extremely foggy now, with a howling wind that made it hard to even hear each other speak. Through the fog, we spotted a gold shimmer of light at the top of this small mountain and decided to investigate. As we climbed up a little higher, we were able to make out this shape as a temple, so we decided to climb up to the top to take a look.

The trek up to the top was quite treacherous. The only way up were makeshift stairs made of slippery rocks, and we had to contend with the wind that was determined to blow us off the mountain. Still, we made it up, and were greeted with the site of a beautiful small temple dedicated to the god Murugan. After spending some time in silence to take in the views, and taking some pictures as well, we made our slow and cautious descent to the bottom.

We reached town later that night after winding back up and down those mountain hairpin bends, and were greeted with the bustling downtown streets of Ooty. There were clearly many shops dedicated for tourists, but the town still had its unique charm. We ate a hearty dinner at Adayar Anandha Bhavan (A2B) that warmed us up from the cold, and then headed to our overnight accomodation.

Through some connections, we had booked a place at Sabol Resorts, a collection of two- and three-bedroom clay-roofed cottages on the top of a mountain overlooking a lush valley below. Since we only got to our cottage after dark, we enjoyed a brief campfire outside and then quickly fell asleep.

The next morning when we awoke, we were greeted with a panoramic vista over the valley below that we were not able to see the previous night. The weather was also much warmer than the previous day, with the sun intermittently peeking out of the clouds. We explored the resort a bit more, including spending some time in the game room where Suhaas destroyed me both at chess and ping pong (still fun though!) and planned the places we wanted to see.

We first headed to the Ooty Tea Museum and Chocolate Museum, these two industries begin integral to the area’s economy and history. We were able to learn a lot about the process of making these, and were able to sample delicious dark chocolate as well as seven different speciality teas, from white tea and green tea to cardamom tea (hands down the best!).

After our museum visit, we then went to the other highlight of Ooty, the Botanical Garden. Having visited the world-famous New York Botanical Garden countless times during my childhood, I was doubtful about why this much smaller garden in Ooty was so special. I was pleased to have my expectations exceeded, and I’d say that this garden was definitely one of the highlights of this trip, as you can see by the vibrant pictures below!

Soon after our garden visit, we decided to start heading back down the mountain since we’d be driving this time and did not want any traffic to delay our arrival back at Coimbatore Junction for our train. On the way there, we stopped at Mettupalayam for lunch, where I was surprised to find another location of the Border Parotta Kadai we were unable to visit at Kutralam. Celeste and I bounced on this opportunity, and we had some amazing parottas here for lunch.

We then drove back to Coimbatore, where we made it to Coimbatore Junction on time for our train back to Madurai at 7:30 pm. Our train, the Coimbatore-Nagercoil Express was waiting there already, so after walking around on the platform for a bit, we were able to board and get some sleep as we headed back towards Madurai.

We arrived back in Madurai on time at around 12:45 am, and headed straight back to Inspiration to get enough rest for work later that morning.

This post has already gotten quite lengthy, so I’ll leave the remainder of our travels for the next one—stay tuned for that, and I hope you enjoyed getting a glimpse of our first couple of adventures across Tamil Nadu!

Price regulation in a higher education market: unintended consequences?

Sun, 08/14/2022 - 21:02

Tuition prices have been regulated in most private higher education markets (i.e. in nearly all states) in India since at least the mid to late 1990’s. This write-up aims to shed light on some possible consequences of a fee regulation policy enacted in the Tamil Nadu engineering college market in 2017. I find suggestive evidence that the fee regulation policy which increased out-of-pocket expenses for all students and SC/ST students in particular, had two main consequences.

First, we see a 20% decline in total engineering enrollment immediately after the policy was enacted in 2017. This downward pattern is consistent across all caste groups and in particular, SC/ST students who were the only caste group with an upward trend in engineering enrollment percentages, drop their enrollment by nearly 33% the year after the policy was enacted and continue to drop in subsequent years. Second, we see that after the policy is enacted, general category students increasingly enroll in expensive and potentially higher quality private engineering colleges (affiliated to private universities). Changing the nature of fee regulations and related out-of-pocket tuition expenses for students can potentially alter students’ (i) preferences and choice of college and (ii) their potential post-college and longer term outcomes.

The policy implications of fee regulation policies can be significant and lasting. On the engineering college supply side we see that nearly 50% of engineering college seats in TN are unfilled because of decreased demand (often a direct consequence of increased prices). On the student or demand side we could suspect that poor students who are unable to access certain colleges because they are priced out of the market or have had their scholarship amount decreased will either quit engineering college admissions and pursue another degree or may even quit higher education altogether if they believe alternate degrees are not worthwhile. 

In Table 1, we see that there are three types of colleges where an aspiring engineering student in Tamil Nadu (TN) can enroll. They are Anna University (AU) Public colleges, Anna University (AU) Private colleges, commonly known as self-financed colleges, and Non-AU Private colleges. The first two types of colleges are affiliated with Anna University (the apex public engineering university in Tamil Nadu) and the third type of colleges are affiliated with private “deemed” universities. AU public colleges are generally considered to be the most elite institutions and are highly sought after by students, which naturally makes them the most competitive for admissions (e.g. College of Engineering, Guindy). AU public colleges account for about 7% of total enrollment in the state in an academic year. We observe in columns 6 and 7 that these colleges have historically been the cheapest to attend and their price has been fixed at Rs. 8k. AU private colleges account for the overwhelming bulk of both, the supply of engineering college seats (~90%) and engineering enrollment (~76%) in TN state. These colleges vary vastly in the quality of education and skills that they provide to students. Additionally they are in general more expensive than AU public colleges. Within AU colleges there are two types of seats that a student can access, namely central category seats, commonly known as “merit quota seats” and discretion seats otherwise known as “management quota seats”. 

Central seats account for the entirety of seats at AU public colleges and at least 65% of seats at AU private colleges. Admissions to central seats at AU colleges, both public and private, occur through the Tamil Nadu Engineering Admissions (TNEA) centralized process. Students submit their 12th grade board exam marks and college preferences to the TNEA. Using a centralized matching process the TNEA allocates the optimal colleges to students conditional on their board exam marks.  Note that central category seats are the only ones that have government mandated affirmative action regulations pertaining to them. Discretion seats can be awarded to students completely at the individual college’s discretion. They can be awarded based on students’ ability (measured by their board exam marks) or based purely on student willingness-to-pay or a combination of both. Non-AU private colleges which account for about 17% of enrollment on average (increasing in recent years) have no central seats and therefore no affirmative action rules pertaining to them. They are usually the most expensive engineering college seats in the market and generally provide high quality education and boast good post-college placement records. Non-AU colleges have their own admissions process separate from the TNEA. Since AU public colleges have always been cheap and Non-AU private colleges are outside the state government’s jurisdiction with regard to fee regulation, it is clear that fee regulation and affirmative action policies only affect AU private colleges. 

The main policy in question is explained in Table 2. We see that there are reserved central seats for BC (Backward Caste) and SC/ST (Scheduled Caste and Scheduled Tribe) students, at 50% and 19% respectively for each group. General category students do not have any reservations pertaining to them. As we see in columns 5 and 6 of Table 2, central seats are more expensive in absolute terms starting in 2017, but are always free for affirmative action students (i.e. BC and SC/ST). However the main change that seems to have affected SC/ST students is shown in red. In column 5 we see that SC/ST students could get admitted to discretionary seats at colleges for free, i.e. the government would bear the expense for them and compensate colleges directly. Starting in 2017, we see that the scholarship amount was capped at Rs. 50k meaning that SC/ST students need to pay Rs. 35k out of pocket for a discretionary seat that was previously free. Moreover we see that general category students who always had to pay full price for central and discretionary seats see a price increase across the board within the Anna University system.

Figure 1 helps us understand the possible implications of the fee regulation policy on enrollment of first year cohorts. There are three main takeaways from figure 1. First, in the top left panel of figure 1, we see that total freshman enrollment has been declining approximately between 3-6% yearly before 2017 but experiences its most significant decline, around 20% relative to the previous year immediately after the price regulation policy. Declining enrollment in AU private colleges is primarily responsible for this trend and enrollment in AU public and Non-AU private colleges appears quite steady across time. Second, in the bottom left panel of figure 1, we see that SC/ST students who were increasingly enrolling in engineering colleges until 2017, drop their enrollment by nearly 33% immediately after the policy and by 2019, SC/ST enrollment is 44% less than the last pre-policy year. Recall that in the pre-policy period SC/ST students could attend engineering college through central and discretionary seats for free. However in the post-policy period, they are required to pay Rs. 35k out-of-pocket for a discretionary seat. Although this amount is less than the Rs. 85k that BC or General students would have to pay for a discretion seat, we could interpret this as evidence that SC/ST students either cannot afford to pay a non-zero amount for an engineering degree, or are unwilling to pay out-of-pocket for an engineering degree. Unfortunately without separate data on enrollment in central and discretionary seats we cannot make a definitive statement about the exact number of SC/ST students in each type of seat pre and post policy. 

Third, in the bottom right panel, we see that General student enrollment at AU private colleges has been declining at the fastest rate relative to the other two caste categories. However, although General students account for only 5-10% of the population of TN they comprise anywhere between 18-25% of the engineering student body. We observe that General students are leaving AU private colleges and increasingly prefer the more expensive, likely higher quality Non-AU private colleges. In the post-policy period, as AU private colleges become even more expensive than before and the prices of AU private and Non-AU private colleges converge, we observe General enrollment at Non-AU private colleges overtake General enrollment in AU private colleges by 2019. 

It is important to understand the policy implications of this fee regulation policy. It has the potential to change marginalized students’ access to college by making colleges more expensive (i.e. discretion seats for SC/ST students) or even change the student composition of classes by making certain options (i.e. Non-AU private colleges) relatively cheaper and therefore more attractive to those who can afford them. High quality and high willingness-to-pay students departing the Anna University system and large declines in enrollment because students simply cannot afford to pay for engineering college can have deleterious effects on the entire engineering college market as colleges are no longer able to attract demand as well as labor market effects as the overall quality of engineering education could decline. 

Glimpses into Indian Efficiency

Thu, 08/11/2022 - 01:43

In addition to the beautiful culture and work ethic of India, one thing I have come to appreciate greatly is Indian efficiency. I’ve noticed that efficiency in India comes in many forms: whether that be sustainability to protect the environment, efficiency in the workplace, or efficiency in communication. Throughout my trip abroad, it’s been incredibly interesting to venture out within India and explore the innerworkings of how people and institutions operate in their routine. Below are the appreciable observations of efficiency I’ve made so far:

Electrical efficiency:

  • Motion Detected escalators: On my second day in Gurgaon, I was already struck by the innovations of efficiency. My co-intern and I visited the Ardee mall where we noticed motion detected escalators. These escalators only begin moving when they detect a person in close proximity. Though a small effort, it seems to be a very easy way to limit daily energy expenditure in public spaces. Thankfully, I saw these to be very widespread in public areas in Gurgaon.
Ardee Mall
  • Power outlet switches: In every single home I’ve visited, along with the power outlet, there has always been a switch. The first time I went to charge my phone in India, I made the mistake of not clicking the power outlet switch which left me with a dead phone the next morning! This is such an efficient alternative to power outlets whose circuits are always drawing electricity. If you see these, make sure you check your devices are charging before leaving!

Water Efficiency:

  • Water Tanks: In my last blog posted in June (so long ago, I know!), I was in Gurgaon. Due to some circumstances, my co-intern and I ended up in Chandigarh, the city where the entirety of my extended family lives. The weeklong visit in Chandigarh was refreshing from the bustling nature of Gurgaon as I found it to have both better weather (much cooler!) and to be more peaceful. During this trip, I stayed at my grandparents’ house where I became familiar with the fascinating water tanks, endearingly called “tankies”! This is a North Indian slang term for water tank!
  • Household Tanks
  • Rooftop Water Tank + Mountains
  • 10,000 L Tank
  • Rooftop View
  • Rooftop Temple View
  • Chandigarh visit
  • Chandigarh visit

When I was visiting, their house was filled with conversations about how much water to store in buckets so that it could be used further on in the day. This was because the tankie was in need of its routine cleaning, and to do so, it had to be emptied of all the water it currently contained.

Tankies can be found on top of almost every house in India. They store a good deal of the water consumed in the household. In some houses, there’s only a few taps that draw water from the government water storage facility. This running tap water is not always dependable because the government given water has scheduled water outages during the day (for example, water may go out from 9 AM to 6 PM during the day)! This is done in an effort to conserve water and with the expectation that all other water will come from the tankie. So, people use the store of water in the tankie for their daily usage. In large apartment complexes, one can find an underground tankie that stores as much as 50,000 liters for residential use! A motor draws up water from the large tank downstairs that refills the upper tank as and when water is being used up. The individual household tanks are typically located at the top of the house because this elevation allows for gravity to generate water pressure. As a result of this pressure, the water flows down the pipes into our faucets as demand is initiated.   

For hot water, people have geysers installed that must be switched on to begin heating tankie water for use. If you want hot water, you must turn on the geyser in advance! As they are storage tanks, tankies must be cleaned by professionals at scheduled times to avoid water contamination.

  • Geyser

Efficiency in Local Markets

Though a bit of a stretch from what people typically attribute to the word “efficiency”, I found some degree of efficiency while shopping in local markets.

Staying in Delhi throughout the month of July gave my co-intern and I the ability to easily explore the many flea markets scattered throughout Delhi. Here, I found efficiency in the way that shopkeepers sold their goods. And that was, bargaining! I found that their method of bargaining to sell their items was incredibly effective, because they were usually willing to compromise on prices in order to sell the maximum amount of goods during the day. The same was true when my co-intern and I took a visit to the local market on our quick trip to Gujarat!

While we’re speaking about my favorite local markets, here’s a quick guide on what they contain and how to navigate them because they can definitely be a bit overwhelming:

  • Sarojini Nagar: This market is well known for its daily wear western clothing. You can also find beautiful jhumkas (earings) here for just 50 rupees and shoes for 100 rupees!
  • Lajpat Nagar: This market literally has everything! From bedsheets and comforters to ethnic clothing, I was overwhelmed with the insane amount of variety in Lajpat.
  • Janpath Nagar: This market is known for its abundance of handicrafts. We saw a lot of traditional jewelry and Indian souvenirs here. Ethnic clothing and beautiful traditional bags were here too!
  • Dilli haat: This is not a traditional flea market as it is government owned and run. The attraction of Dilli haat is that it contains handcrafted items, clothes, and food from multiple states of India. So, for those that aren’t able to travel throughout India, take a trip to Dilli haat to see a glimpse of the rich yet diverse Indian culture. On my trip to Dilli haat, apart from all the unique jewelry and clothing I saw, I also got to taste Dabeli (traditional Gujarati & Maharashtrian dish) and Dosas (from a shop representing Tamil Nadu).
  • Gujarati market– This was one of the most beautiful markets I visited! The sheer variety of fabrics and patterns was astounding in the street market we visited in Ahmedabad. The colors and patterns were so alluring that I bought a Gujarati “chaniya choli” dress for myself! I can’t give many tips for bargaining in this street market since I don’t know the Gujarati language, but my suggestion here would be to find someone local to help you out for the best prices!
  • Chandni Chowk– While on our Old Delhi Street Food Tour, we passed through Chandni Chowk while sitting in an e-rickshaw. No shopping was formally done, but I can honestly say I have never seen that level of variety in beautiful dresses anywhere else. Each lane had something new to offer: one was dedicated to bridal lehengas, another to sari borders, and another to jewelry. But of course, remember that the food is also a commodity that cannot be missed! Just make sure the street food is safe which a local/guide can confirm.
  • Sabzi Mandi: While in Chandigarh, I took a quick visit to the “Sabzi mandi” with my aunt. This translates to vegetable market. It was located right down the street from her house and its vendors make a scheduled appearance every Monday. The market was truthfully something amazing! There were so many vegetable vendors everywhere that it made it impossible to see where the mandi began and ended. To add to the fun, cows were strolling through the market along with us, illuminated by the bright lights of each stall. And of course, bargaining was in full swing here too!

*Bargaining tip: What I’ve learnt is that bargaining is a must in these markets. This is because shopkeepers have usually already significantly marked up prices on their items with a hefty margin for bargaining. Though, definitely don’t try bargaining in shops that clearly say “fixed price” as these are present within the local markets as well. I’ve heard and observed that consumers quote a price 50% less than the price given by the shopkeeper and continue to comprise on it, making sure to pay no more than 70% of the initially quoted price. I would recommend however, not trying to excessively bargain because everyone is still trying to make their end’s meet. A decent bargain makes both parties happy. A trip to the local market will surely help you hone in on your negotiation skills! Because of this, shopping became such a fun activity (despite the intense heat) because I got to practice my Hindi with shopkeepers as well as buy gifts and traditional items for good prices.

  • Lajpat Nagar
  • Chaniya Choli Assortment
  • Chaniya Choli
  • Guajarati Market
  • Chandni Chowk
  • Sabzi Mandi

Efficiency in the workplace

Besides efficiency found throughout the routines of daily life, I’ve also found pockets of it while working at PHFI. After the pandemic ran its course, PHFI shifted to a predominantly hybrid model such that there are two in person workdays during the week while the rest of the week is virtual. This left my co-intern and I with a lot of time to balance our days between working and exploring India. At this time, I found that PHFI’s decision to shift to a hybrid model was an effective one because it serves their work culture well. Moreover, hybrid models have been found to improve mental health due to increased proximity with family as well as improved productivity due to the necessity to plan out in-person and virtual workdays.

At work, my co-intern and I have been conducting literature reviews on tobacco use among adolescents as well as the efficacy of peer education on various adolescent health themes. We have also been working on policy briefs relating to overweight/obesity issues in India and government regulations to mitigate its prevalence as well as the use of front of package labelling. In between, we’ve been working on devising a protocol for the scale up workshops for the RKSK program I described in my last blog. Essentially, the RKSK program is currently in its pilot phase and our field visit was a qualitative data collection visit to the pilot districts within Madhya Pradesh. Now, after the success of the pilot projects, the program has the ability to be scaled up nationally. One step for this scale up to occur is to have workshops where all stakeholders in the program are in attendance to get an understanding of how the program can be effectively scaled up as well as have all their concerns and issues addressed. My co-intern and I have been in the process of writing up a protocol for the workshops.

It’s interesting how many unique learnings can be made just by carefully observing daily life in India. My visit so far has offered me so much more than just learning from my internship as I have gained knowledge through explorations of local markets, glimpses into incredibly efficient daily routines, and environmental sustainability! Stay tuned in my next blog to learn about my trips across India and the beautiful festivities I’ve had the privilege of taking part in!

Always Perfect

Mon, 07/18/2022 - 11:24

The week before my birthday, I enjoyed cake almost daily through a series of fortunate events. First, a group celebrating a girl’s second birthday at Madurai Eco Park offered me two slices of chocolate cake after I walked by. The following evening, we went to Haran’s house (and ate chocolate cake) to celebrate the conclusion of his internship. Haran had been an intern in the quality and patient safety office since February, and he was usually the first one there and the last to leave. At work the next day, there was a a joint clinical meeting on needle stick injuries attended by every hospital’s top leaders and microbiology departments. Once the meeting ended, the mood immediately shifted as we celebrated the birthday of Dr. Kim (AEH Madurai’s CMO). Dr. Kim’s cake wasn’t chocolate, but rather a caramel K-shaped cake decorated with frosted stock images relating to hospitals and leadership. Finally, the day before I turned 20, my project guide Ushalini surprised me with cake (chocolate again) while the entire office sang to me. I tried my best not to tear up, but my eyes did get a little watery. 

The wish I made when I blew out the candles was just to keep feeling as happy, at ease, and loved as I did in that exact moment. I know there’s the superstition to avoid sharing birthday wishes or else they won’t come true, but the world has enough good to go around.

The day of my birthday, we took Saturday off to go to Courtallam (alternatively spelled Kutralam), which is nicknamed the Spa of South India. We first headed to Palaruvi Waterfalls in Kerala, where we could bathe in the pools and hike up the mountain to enjoy the stunning morning views. Aravind’s Tamil skills came in handy as he secured tickets at the price meant for locals, and the rest of us tactfully kept our distance. We also marveled at the monkeys as they deftly swung down the face of the mountain and provided us with lots of laughs.

  • Palaruvi Waterfalls in Kerala. Palaruvi means “stream of milk” in Malayalam.
  • The Courtallam Five Falls. Women stand under the left two falls and men stand under the right three falls.
  • The Nilgiris. The views from the car ride down the mountain were even more dramatic, but dozens of hairpin turns made it impossible to capture the beauty fully.
  • Suhaas smizing it up while we walk to the steam train.
  • Government Botanical Garden in Ooty.
  • Fully grown Asian elephant with cute pink freckles of depigmentation.
  • Mama monkey holding a wrinkly baby monkey in the mountains.
  • Hiking towards the Old Courtallam Falls.
  • Look up!

After our quick visit to Kerala, we hopped from waterfall to waterfall in Courtallam. The waterfalls were all separated by gender, and every woman was fully clothed in the water while some men sported bathing trunks. The men aggressively shoved each other to get the optimal spot with the maximum water pressure, but the women were much gentler. Many made space and held my hand so I could bathe more directly under the torrential streams of water. Standing under waterfalls gushing from the mountains and being embraced by women from all walks of life was nothing short of a transcendent experience. I was especially touched by a girl called Azima, who took special care to make sure I was safe in the crowd at the Five Falls and could fully enjoy the experience with a new friend.

Our first longer group trip together was when we visited Coimbatore and stayed with Aravind’s family for the night. I cannot emphasize enough how accommodating Aravind’s mom, grandparents, and uncle were, and we are all extremely grateful for their hospitality. The next morning, we took the iconic Nilgiri Mountain Railway train from Mettupalayam to Ooty (Queen of Hill Stations. Also a fun name to repeat aloud). I stretched my head out of the window throughout the 5-hour-long ride, absolutely in awe of the stunning mountain views and the vehicle itself. People from every section of the train yelled in unison whenever we rode through a tunnel, and the whole experience was more magical than a Disney ride.

As the track climbed to a final elevation over 7,000 feet, the scent of the air gradually changed from sweet and floral to crisp and evergreen. The second sign of our increased elevation was the 50-degree temperature, and both the clear air and the cooler temperatures were a welcome relief from Madurai’s heat. Once in Ooty, we took a safari through the Mudumalai Tiger Reserve, toured a chocolate and tea factory, and explored the botanical garden. The chocolate samples were good, but the tea varieties we tried (cardamom, masala, normal chai, white, green, and ginger) really hit the spot. When driving back from Ooty to Coimbatore, we were able to try a famous restaurant called Courtallam Border Rahmath Kadai at a rest stop. Ironically, we didn’t eat at the original location in Courtallam because it was so crowded, but their nattu kozhi porichathu was the tastiest chicken ever. Even thinking about it now makes my mouth water.

  • Madurai Junction (MDU) station just before 7 AM.
  • View from the train window at the Thirupparankundram station en route to Tuty.
  • Canteen in a coral reef paradise.
  • View from the deck of a docked fishing boat.
  • Pairs carry baskets of fish from the ocean to be dried on the sand of Harbour Beach.
  • Basilica of Our Lady of Snows. Catholic and Tamil traditions are mixed, as evident in the jasmine garlands around Jesus and the Blessed Virgin Mary.
  • A zoomed out perspective. In India, the Catholic Church is the largest Christian church. Mass conversion of paravars began in the 1500s, and that influence continues in Tuticorin today.
  • Why does the air smell so strongly of salt? Answer: salt pans. I never thought of salt as a crop, but people work hard in intense heat to harvest mountains of salt from the land.
  • People and boats enjoying the beach.

Most recently, Aravind and I traveled with his mom to Tuticorin. This was our first time taking a train in the AC 2 class, which was only slightly more expensive than AC 3 and came with the perks of more vertical space between beds, more outlets, and privacy curtains. While we were hoping to ride the glass-bottom boat and go snorkeling at Tharuvaikulam beach, the water conditions made that plan impossible. This setback gave us more time to explore other parts of the city, and we still got our fix of an adventure on the water through kayaking. If Courtallam was for waterfall hopping, Tuty was for exploring various beaches and literally savoring life at a comfortable pace. Food savored in Tuticorin included neem berries from a tree by the V.O. Chidambaranar Port, calamari, poricha parotta, king coconuts, and Ganesh Bakery’s famous cashew macaroons. 

Back in Madurai, I’m now much more comfortable with the lack of sidewalks and pedestrian-friendly crossings and have been exploring the city as much as possible after work. College has conditioned me to think everything is walkable enough, and I actually feel much safer on the streets of Madurai than in the US. I definitely get some stares and double takes, but I also get a lot of waves, hellos, and smiles wherever I go. My favorite location for a walk is the Vandiyur Mariamman Teppakulam, which is a large temple that comes to life at night. Of course, there’s no shortage of other temples to admire, and I also really appreciate the vibrant colors of all the buildings here.

  • Vandiyur Mariamman Teppakulam, an illuminated temple surrounded by a water tank.
  • The Gandhi Memorial Museum, which famously houses the dhoti Gandhi was wearing when he died.
  • Madurai District Collector’s office
  • Two of the most common sights in the city: auto rickshaws and temples.
  • Poster by the Vaigai River bank advertising Minions: The Rise of Gru. We watched the movie at the Vishaal De Mall with Miral’s brother and cousin, and the theatre was packed.
  • An outdoor market that would make the minions go bananas. You can find 16 different varieties of bananas in the market!
  • Children playing in front of the Kazimar Big Mosque. The mosque was built in the 13th century, making it the oldest mosque in Madurai.

Exploring the city with Sylvia, a Stanford student studying Tamil in Madurai for the summer, has led to many spontaneous adventures. One restaurant that I highly recommend is Ayyappan Dosai Kadai. Our server was the restaurant owner, the chef making all our dosas was his wife, and the lady greeting us from the counter was his mother. Sylvia and I didn’t order anything ourselves, but he brought out countless flavorful dosas to see our reactions once we tried them. At the end of the meal, he gave us a generous discount because we were foreigners and therefore his family’s guests. Our entire dinner cost only 80 rupees per person, which is ~$1. To be fair, every time I see the bill at a restaurant, I feel like I’m paying way too little. And luckily for us, the exchange rate has kept shifting in favor of the dollar, so it’s not like we’re getting ripped off at any other restaurants. However, no other restaurant has given me the special “family” discount, so Ayyappan Dosai Kadai will always have a soft spot in my heart.

On another one of our evening excursions, Sylvia and I saw two young female tourists by the Meenakshi Temple, and in our excitement I almost ran off with my glass of fresh pomegranate juice just to say hi. There’s very few foreign tourists here, and even fewer of them are young women, so we were surprised to see them. We did eventually chase them down (not in a creepy way, I promise) to drink filter coffee together and chat. Clara, who’s from New Caledonia, had one tattoo in Hindi that translates to “always perfect.” When I asked about the tattoo’s meaning, she provided several funny anecdotes of times in India where everything was going awry. Each time, she would end the story with exclamations of “ah, always perfect!” She approached life with the attitude that no matter how disappointing an event seemed, she knew the outcome would be better than she imagined. In fact, perfection would often come as a direct result of the disappointments. While I am not as well traveled in India as Clara (yet!), I will definitely keep her catchphrase in mind wherever I go.

Unfortunately, it’s clear that not all problems can be waved away with a casual “always perfect.” The optimism of always perfect felt especially hollow in late June and early July. The overturning of Roe v. Wade and the Highland Park mass shooting were both beyond devastating, and they deeply affected my feelings of security in my body and the Chicagoland community I call home. Processing these events again, but from the perspectives of Indian news media, sent even more waves of anger and grief over me. Being in India makes it much easier to question the American status quo and dream of better alternatives. India legalized abortion two years before Roe v. Wade, and in 2021, India’s MTP Amendment Act expanded access to abortions to reduce maternal mortality. India has some of the strictest gun ownership laws in the world, whereas the US clings to the Second Amendment and has suffered hundreds of mass shootings this year.

Obviously, these two democracies are very different. One small example of these differences is the omnipresence of the current Chief Minister of Tamil Nadu, M.K. Stalin — yes, he was named after Stalin. M.K. Stalin’s image is pasted everywhere, even behind the counters in some of the street stalls or on the dash of an auto. His approval rating is also higher than many politicians in the US. I’m not saying that huge public posters of Joe Biden will save his approval ratings (sorry Joe). We don’t need to be that dedicated to politicians. But we do need our policies to be more dedicated to protecting people’s lives, and I think India offers some promising possibilities on that front.

Of course, no place will ever be perfect. Even the Constitution’s “a more perfect union” implied perfect to mean improved, not flawless. “Always perfecting” might be more appropriate than always perfect, at least when it comes to bigger issues. Lisani’s project is related to kaizen, or continuous improvement. This attitude is something that AEH engrains in its operations and can apply universally. No matter how advanced a system is, there will always be room for improvement.

With that said, I will close with a few (more work-related) highlights: 

  • Grand rounds! These are mostly attended by PGs but are explained clearly enough for anyone to follow. Grand rounds have covered clinical cases of lupus, orbital cellulitis, retinoblastoma, craniofacial fibrous dysplasia, orbital schwannomas, and Sjögren-Larsson Syndrome. Beyond just discussing the diagnosis and prognosis, grand rounds are also pep talks and reminders to focus on patients first. On July 7th, the grand round was a commemoration of Dr. V and his mission. The commemoration meeting only lasted half an hour, and then everyone returned to work. 
  • A fresh batch of village girls came to interview and apply for MLOP positions, which are a major source of personal and economic empowerment. Once they begin working, they can call home once a week and see family once a month. When the girls reach their mid-twenties, most will get married and leave AEH. Speaking with the full-time MLOPs, it’s easy to see how some can become burned out from the long hours and the distance from their families. The sisters also are not allowed to have phones, but they never fail to find other ways to stay positive.
  • Touring Aurolab, which manufactures ophthalmic consumables for AEH and over 160 other countries. I was most struck by the sheer manpower (womanpower) of the workers as well as their intense focus on every detail. The building was full of signs reminding workers that “every 15 seconds, somewhere in the world, an Aurolab IOL (intraocular lens) is implanted.” I initially assumed Aurolab mostly makes IOLs, but they produce a wide array of other products like suture needles, surgical blades, drugs, and medical equipment. Aurofarm is another section of the campus with organically grown plants, strutting peacocks, and a building in honor of Dr. V.
  • Meeting Karna in the Inspiration lobby of all places. His family business, Neu Micromed (not an ad), does an impressive job of manufacturing ophthalmic surgical instruments and medical furniture. Kind of like Aurolab, but in Ahmedabad. As Karna explained, it’s easier to start this kind of company in India than in other countries, and the supplies made are then exported to other LMICs. 
  • Becoming more and more comfortable in the cataract department and the operation theater (OT). The synergy between all the staff (doctors, fellows/PGs, MLOPs, housekeeping, sterilization…) is beautiful. Even watching the surgical monitors is mesmerizing. I feel very lucky that as a project student, I’ve been meeting with people at all levels on both the clinical and the management side and observing many areas of the hospital to see how the pieces all fit together. Aravind has the largest cataract department in the world, so it’s a real treat to be a small part of it. More on this in a future post!
  • Excellence in sight at Aurolab.
  • Whiteboard on the wall of a patient counseling office in the cataract department.
  • Browsing at the Gandhian Literature Society Book Shop. “The more the mind is quiet, the more the sight is good. Blessings.”

Filling Big Shoes – Month 1 at Aravind

Mon, 07/18/2022 - 00:45

When I found out I was selected by CASI for this internship at Aravind, my mind was immediately filled with questions: What would life be like there? Would I be able to fit in? How could I, just a first-year in college actually make a difference in this massive, world-renowned institution? Based on quick searches of TedTalks done by members of the Aravind management and talking with past CASI interns at Aravind, I knew there were certainly big—no, massive—shoes to fill.

After a little over a month here, I most certainly have settled in and found a routine here. My project is slowly progressing, day by day, I have learned many of the ins and outs of the Aravind Eye Hospital (AEH) system, and have even made many close friends amongst the hospital staff, my project guides, and even fellow interns here at the Inspiration Hostel.

Learning, meeting, and doing—these are the three ways I’ve mainly been spending my time.

Working on my project at Aravind

Upon arriving at Aravind, there was definitely a lot to learn. While I was certainly eager to start on my project, it was fascinating first learning about all the inner workings of the system that I had previously only read about on the surface level. On our first day at LAICO (Lions Aravind Institute of Community Ophthalmology), the building where we work most of the time, we were first given a morning-long presentation on everything about AEH. One of the most inspirational parts of this was learning about the early history of AEH, and how Dr. G. Venkataswamy was forced to overcome so many hurdles in his own life before even coming to a point where he could start writing the first pages of the Aravind story. His tireless dedication to the core mission of “infinite visions”—preventing and treating eye diseases to create a blindness-free India was an invigorating inspiration for my own project here at Aravind. Learning about the nurses, or MLOPs (mid-level ophthalmic personnel), the main workforce that drives the AEH system forward, was particularly interesting. They are recruited straight out of high school, given a two year training, and then have a three year mandatory work period here. This raised many questions about their experience here that I was curious to find out more about. On our very first afternoon, we were thrown into the deep end with patient shadowing: accompanying a patient throughout their whole treatment process at AEH. It was amazing seeing everything we learned that morning actually in action, from patient registration to initial refraction and vitals check, to actually meeting with a doctor for consultation and finally counseling to help with treatment adherence.

By the end of the first week, I had honed in upon my project area. I am broadly interested in preventive medicine and in conjunction developing effective methods for screening and treating pediatric diseases, so I wanted a project in this area. Serendipitously, the AEH Pediatric Department was encountering a problem with their amblyopia patients. Amblyopia, also known as “lazy eye” occurs when one eye has a significantly higher refractive error than the other, eventually leading to vision loss of the weaker eye. Affecting almost 5% of all children in India, it is the leading cause of childhood vision loss here. It is also particularly difficult to effectively treat—the only proven method over the long-term is patching or covering the stronger eye to force use of the weaker eye. The main problem was that patients were not adhering to this patching treatment paradigm, and also not attending follow-up appointments to assess their progress. My project would be to analyze the factors causing this, and develop solutions to effectively improve treatment efficacy.

Still, my project seemed extremely daunting. How could I possibly create any effective solutions as a first-year college student when I was surrounded by leaders in medicine and healthcare delivery with decades more experience than me? Meeting my project guides, the main contact points who would be helping with my project, definitely helped assuage some of these fears. My first main project guide is Dr. Janani. She is one of the Medical Officers, or doctors, in the AEH Pediatric Department. My other project guide is Mr. Murugaraj, who works in the AEH DTP department, and mainly works on patient outreach and communication.

We first met as a small team so they could teach me about the problem in-depth and introduce me to some other key people in the pediatric clinic with whom I’d probably be working with on this project. Progress was at first quite slow—everyone, especially the medical officers, being busy with their full-time jobs, it was difficult to arrange any meetings with anyone, sometimes even my main project guides. Back at Penn, I’m used to emailing professors or TAs and scheduling time to meet with them. This clearly was not working here. This brings up one of the main differences in workplace culture I have experienced here—people were more than glad to meet with me if I simply walked into their office and asked my questions. While this would not be considered appropriate at home, it seemed to be the norm here, and once I started doing this more, I found it much easier to meet with people I needed to.

Over time as I started to get acquainted with AEH and became more settled-in, progress slowly started to pick up pace. With the help of my newfound friends and colleagues in the pediatric clinic, most notably Aruna sister (the head pediatric counselor), I began to start interacting with amblyopia patients and speaking with kids and parents about their concern. Based on my initial observations, I created a questionnaire in Tamil with the help of Mr. Murugaraj, and deployed this in the clinic to get a more detailed sense of amblyopia patients’ main challenges with treatment adherence and follow-up appointment attendance. Along with this, I also began working with the IT department to get access to a limited set of patient data in order to call patients analyze a broader sample set. As I began arranging more meetings and interacting with more people around AEH, I found that the experience became much more enriching, and my project started moving along significantly faster.

It is not just my project however that is part of the AEH experience. Two of the highlights are the Grand Rounds on Thursday evenings and Journal Club on Friday mornings. Grand Rounds consist of a presentation on a salient topic pertinent to the hospital, presented either by a Medical Officer or some Post-Graduate (PG) fellows. Some of the most interesting topics so far have been 3 case studies on retinoblastoma and conducting familial genetic screening as a method for early disease detection. They explained how Aravind is able to do this screening very cost-effectively, and even cited Penn as an example of an institution that does not conduct cost-effective screenings! Friday mornings at 8:30am (if I manage to wake up in time) consist of attending Journal Club, which is a discussion on a pertinent research paper on a different ophthalmology-related topic each week. These have also been really interesting and allowed me to learn about other areas that are not directly related to my project.

One last thing I’ll mention in this section is our visit to a nearby vision center (VC). VCs are Aravind’s model for conducting primary eye care. They are essentially small rented-out house-sized buildings in small towns around Tamil Nadu and are staffed by two MLOPs. These serve as the first line of eye care, being an initial point of contact and treatment center for patients with basic vision issues, from simple refractive errors to eye injuries. We visited a VC at Alanganallur, a town bordering the outskirts of Madurai that is famous for the Tamil bull-riding sport of jallikattu. Being very interested in primary care as the main model of effective healthcare delivery, I enjoyed talking with the MLOPs here and understandings the ins and outs of managing a VC both from a medical and a business perspective.

The people we’ve met along the way so far

One of the best aspects of living at the Inspiration hostel is meeting all the other guests who come to Aravind for different purposes. One of the closest friends I’ve made is Picard, an ophthalmologist who has been here for 11 months already. He has come to Aravind mainly to work with the other MOs in the pediatric department and plan the implementation of some aspects of the Aravind model back in his home country, Tanzania. Picard is extremely nice, funny, and just a joy to be around! Some of my favorite memories are going out with Celeste and him on a 6 AM Sunday morning run at Sundaram Park.

Another friendship I’ve made is with Chansa, another ophthalmologist who has been here for almost one year as well. He is also working with other MOs and is researching the AEH model as well, with the goal of implementing some aspects of efficient medical and surgical treatment of eye diseases back home.

Miral, a design intern from Madurai who is not staying at Inspiration but works nearby us in LAICO has also grown into one of our closest friends. She graciously invited us to her house for lunch one day, where her family welcomed us with their amazing hospitality and I had the best cheese dosa I’ve ever eaten!

Lisani and Srinath have also been great friends over these past few weeks—they are both MBA students at the Thiyagarajar School of Management in Madurai.

We also met Sylvia, a rising sophomore at Stanford who is here in Madurai for the summer to study Tamil. One of her main interests is learning languages—she extremely talented at this! After already learning other South Asian languages like Bangla, she took up the challenge of Tamil this summer. We’ve met with her a few times already, and it’s so interesting to learn about her process behind learning new languages and her experiences traveling to each language’s place of origin in the process of learning them.

Haran is another intern at Aravind who recently finished his internship—he very kindly invited us to his house to visit his family and friends. He also took us on a very exciting motorbike ride through Madurai back to Inspiration late at night!

Lastly, Krishna, who is an intern at Aurolab (Aravind’s in-house medicines and medical device manufacturing arm)—his father leads AEH-Pondicherry. Through several very late-night conversations, we’ve learned a lot about the AEH system and his own future plans in the U.S.

The travels we’ve gone on, and what we’ve done

In June, we primarily focused on spending time in Madurai in order to get to know this amazing city better.

Our first trip as a group happened to be to the AR Hospital, in order to visit the emergency room. Manya unfortunately got slightly bit by a dog as she was feeding it, so we went to ask for rabies shots. Suhaas and I learned a lot about the—let’s just say different—ways emergency rooms are run here. Some aspects were great though—I could not imagine getting a vaccine for the equivalent of 350 rupees back in the United States.

We also visited various restaurants around Madurai. Some of the best were Madurai Bun Parotta (perhaps Madurai’s most famous food), Phil’s Kitchen (a homely Italian place), Appams & Hoppers (Sri Lankan classics), The South Indian (a wide array of local food), and Barbeque Nation (a more Westernized place with and unlimited buffet and tabletop grill).

Another site we’ve visited in Madurai is the Tirumala Nayaka Palace, the former home of king Tirumala Nayaka, who ruled over Madurai and the surrounding areas in the mid-1600s. The ornate palace is amazing to see and experience, from gazing at the intricate, vibrant artwork on the ceilings to hugging the hundreds of massive columns that support the roof.

In the evenings, Suhaas and I have been using our membership at Spark Fitness, a nearby gym. We try to workout many evenings as a way to relieve stress and just have fun. It’s nice experiencing just a few vestiges of home like this amidst a city so vibrant and bustling as Madurai.

That’s all for now, folks—I hope you enjoyed, and stay tuned for the next one (coming soon)!

The Days Are Flying By (Part 2)

Sat, 07/09/2022 - 00:33

EXPLORING

Outside of work travels, Gurgaon itself has had a lot to offer. In our neighborhood itself, we initially made it a routine to take advantage of the “cooler” morning weather (usually 90°F/32°C) and head to the Joggers park around 7:45/8:00 A.M. In addition to making rounds around the park we also tried out the “open gym”, which was a set of assorted outdoor gym equipment, that looked more inviting than many indoor gyms.

Makes exercise feel like recess!

Gurgaon also has quite a few malls including Ardee City Mall, Ambience Mall, Cyber Hub, and WorldMark all of which felt like different takes on indoor shopping experiences compared. In some of these malls and most other public spaces like the train station, more commonplace than in the U.S. and assumptively efficient has been entrance security. They always put bags through the baggage scanner and sometimes scan/pat down the person to ensure no dangerous items are brought inside. Shopping at some of these places has definitely been an experience. Most of these places have had fixed prices, so bargaining has not been a necessary skill just yet, but they do all seem to have something similar to my understanding of shopping assistants. This was definitely odd to us the first time we experienced it. As we entered an empty shop in the quiet mall on a random weekday, we were greeted very kindly but were a little confused when one of the employees followed in our direction and then continued following us. Whenever we’d look back his head seemed to be bent with eyes glued to the screen of his phone. After this happened a couple more times without a word uttered from him, our uncomfort drove us out of the shop despite the great things within. We realize now looking back, it was probably his job to help us with shopping and that if either they or we had attempted to exchange words, the strange tension could have been avoided.

Cyber Hub! Ambience Mall World Mark

In many of these malls, there are also movie theatres. We watched Bhool Bhulaiya 2, which met expectations as sequels do (1 has a special place in my heart). The theater had at maximum 30 seats, all of which were incredibly comfortable and had the function to recline. The classic sticky movie theatre floor was also missed and replaced with a clean carpet constantly monitored by doting staff. It was a pretty different experience.

Bhool Bhulaiya 2

Within and outside of Gurgaon we’ve also been lucky to be invited to a few delicious lunches/dinners with extended connections who have been wonderful people that have also taught us about Gurgaon/Delhi living.

We also ended up taking an Old Delhi Street Food & Sightseeing tour. Apart from the food, it was very cool to learn about the history of Old Delhi; hopefully, the incoming monsoon season won’t interrupt further Delhi exploration.

Views from our Airbnb after the first peek of monsoon season.

FOOD

The food tour covered some of the cruxes of Delhi street food: Dahi Bhalla, Aloo Chaat, Jalebi, Chole Bhatura, Pani Puri, Paranthas, Masala Lemon Soda, and some sweets by the names of Rabdi, Firni, and Sheesh Halwa.

Dahi Bhalla Aloo Chaat Jalebi Pani Puri Chole Bhature w/ guide Abhishek! Rabdi (left) & Firni (right)

Outside of street food, we’ve also enjoyed the Indian counterparts of popular chains back home: Starbucks and Taco Bell. The variety of food choices at Starbucks definitely blew me away. As for Taco Bell, yes, adding “Mexican-spiced paneer” to food does make it better. Their Mexican-spiced paneer was a little life-changing in testing the boundaries of what can be considered a taco.

Starbucks India’s Assortment

We’ve also been able to try more traditional classics including Madhya Pradesh’s poha, Dhaba’s kadhai paneer, a mixed Gujarati and Rajasthani Thali, and Haldiram’s Raj Kachori. Last, but definitely not least are our mango adventures. The highest honor definitely goes to tota puri mangoes with their perfect depths of both of sweet and sour flavor. Otherwise, we’ve been unlucky in catching different kinds of mangoes at the right seasonal period having tried both safeda and dasheri just as their time came to an end; however, our efforts have proven that any mango can taste great as lassi.

Homemade safeda mango lassi!