Day 3: Dec 20th, 2008- Eye camp in Thiruvallur
The third day, a Saturday morning, I left for Hotel Aasai to meet my fellow volunteers there before they left for the clinic. Two new volunteers had just arrived, MaP (there were so many M’s! :) ) and KE, both undergraduate students, possible pre-med; a little jet lagged but only too eager to begin work. After chatting for a bit, we headed to the clinic and loaded the van with camp supplies. Before setting off we stopped at the office just around the corner where the clinic stored donated eye glasses sorted by prescription. At the office I finally met Thanraj, of whom I’d heard plenty by then, the person in charge of coordinating volunteer schedules, arranging eye camps and pretty much overseeing most of the outreach activities in conjunction with Unite For Sight. (I shall have much to say about this very dedicated person and his tremendous commitment to improving health services in rural India in future posts.) We were each given a welcome packet with information about Uma Eye clinic, offered a mobile phone for the duration of our stay, provided with a schedule for eye camps, and some general information about Chennai. Also included in the packet was a cheat sheet with translations of commonly used words and phrases in Tamil. This proved to be a source of enormous entertainment on our drive to the camp! Jokes aside, its utility cannot be overstated, as A and MP will surely attest to.
What appeared to be a large wedding reception hall (or Kalyana Mandapam) was arranged for the day; a very spacious hall, it had multiple side doors allowing cross ventilation and sunlight to pour in. The camp was a ways from the city in Thiruvallur, in North Madras (or Chennai). The eye camp had been organized by the Chennai chapter of the Lions Club and was part of a larger general health camp that included dental checks too.
The patients screened that day covered a wider age range and included many more men and children than on our first camp. Patients, once registered, had their visual acuity measured, following which they were seen by an optometrist to fine-tune their prescription for corrective eyeglasses. They would finally be seen by an ophthalmologist before moving on to the dentists and general physicians. For the purposes of documenting pre-existing medical conditions that could affect their vision, patients were asked if they had high blood pressure or suffered from diabetes. That day I got to do visual acuity tests for the first time. As many of the patients who came in that day could understand some English, language was not a huge barrier. And I must say, MP did a remarkable job of putting patients at ease with her newly acquired vocabulary consisting of eppadi irukkinga? (How are you?) padikka theriyuma? (Can you read?) seri, padiyunga (Okay, please read), while taking turns with me doing the visual acuity tests.
After seeing a few patients, I noticed that while most did a good job of reading the charts on one eye, from having pressed too hard to close the other it took them a few minutes to focus when they had to read with it next. And so, we made it a practice to ask each patient to only gently cup their hand over the closed eye. And it worked really well! In the process of doing the tests we could also really appreciate just how severely a mature cataract affected vision for some of the older patients; The Snellen chart was really no use in such cases as many of them could barely count fingers held up beyond a foot away! Of course, it took a lot of counseling to educate them on the need for surgery. That test was truly their first step towards seeing differently…

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After the camp was nearly wrapped up, we took turns getting pictures of the children who had walked in after school. P in fact, took a particular liking to a dust bin and upon her request many pictures were duly taken of her with it! :) Just as we began considering our options for lunch, the organizers invited us upstairs; they had arranged for lunch- a generous helping of various rice items, venn pongal, sambhar rice, curd (or thayir) rice and shakkara pongal, all served in shallow bowls made of dried banana leaves!
On our drive back from the camp, we stopped at a Hanuman temple that was still being built. The ginormous statue (or vigraha) was apparently monolithic, sculpted out of granite that was fortuitously found just 2 years ago, jutting out of the ground in a quarry in Karnataka. And the inspired owner had had it transported to Chennai; an incredible feat in itself given there had to be no breaks or cracks to the stone in transit.

A few of us were scheduled to observe the regular patients being tested/treated at the clinic later that evening. And with nothing to do between lunch and then, we thought we would find a coffee pub in Anna Nagar to kill the time. MP even knew where the nearest Café Coffee Day was. So again, we braved the walk from 10th Main Rd to Hotel Aasai; the café was supposedly on the way. 15 minutes into the walk, we had that same sinking feeling of knowing we were going nowhere. But upon MP’s insistence we looked for every red sign on the street. We did find a rather garish looking pink and yellow house, but no red sign. A, a regular chaai drinker by then, dismissed the idea of coffee altogether and walked straight to a convenience store to get her afternoon fix and left us to our wandering. At last we found the big red sign we’d been looking for. Yes, we did. Just on the side road parallel to the hotel too. And it was indeed a Coffee Day chain…with a selection of freshly ground coffee beans to choose from, to make our own cuppa filter coffee with, in the comfort out homes.

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That evening, MP, P and I were shown the use of the Retinoscope. For a frustrating few minutes initially, we could not see any reflex because we weren’t focusing the light right. When we did get it right, we took turns using it on each other and were thrilled to be able to really see the difference between an uncorrected myopic eye and one with normal or lens- corrected vision… Another long day of work, yet one full of lessons and new insight.

Just really quickly, the agenda on most days consisted of leaving from the Uma Eye Clinic, based in Anna Nagar in Chennai, to an inner-city slum or a village on the outskirts. A group of volunteers, an ophthalmologist, an optometrist, and two staff members, who doubled as counselors and camp organizers, went on each camp. The bulk of what I learnt about providing quality eye care free of charge to poverty-stricken populations, the infrastructural requirements for such an operation and the hurdles that lay ahead was from these camps.

Day 1: Dec 19th, 2008- Eye camp in Pattalam, near Perambur
This was really day 2, as day 1 was arrival day for most international volunteers, and was spent getting acquainted with Uma Eye Clinic staff and getting a brief overview of the program details.
Day ‘2’ then began bright and early. I arrived at the clinic just before its shutters opened and was greeted outside by Periasamy, one of the clinic staff members who helped organize eye camps. After some of the volunteers (who’d arrived a few days ago) left to observe surgery at the Hande Hospital, the volunteers who’d just arrived were brought from Hotel Aasai to the clinic and we all got on board a van. They comprised two aspiring optometrists, MP and P, one medical student, MR, and a public health major A (each of whom had their own adorable idiosyncrasies and inimitable charm, and all of whom were united in their eagerness to learn and serve! :)). Koteeswaran and Periasamy loaded the van with Snellen charts, reading glasses and all implements needed to conduct a basic vision screening camp. Dr. Senthil, one of the senior ophthalmologists at the clinic and our program contact, accompanied us on that first day. A man of quiet disposition and a very calm demeanor, the enthusiastic barrage of questions from us wide-eyed first-time volunteers didn’t seem to upset his equilibrium, nor did traffic diversions, power outages, supply shortfall or other setbacks, as we were to find out.
We were headed to set up a camp in a city slum in Pattalam, near Perambur that day. It was organized in partnership with Equitas Microfinance in a small brick room at the corner of a narrow and busy street. An open tent was hitched outside, with a registration desk and chairs for patients accommodated in that space. Stray dogs and flies came and went freely as the patients who streamed in. Mr. Sathyanarayanan, the area manager for Equitas, gave us a brief introduction to Equitas. Still in an early stage of its development, it already has 10 branches in various parts of Chennai and is slowly expanding its operations throughout Tamilnadu. Among its many socially conscious initiatives, is partnering with a range of healthcare providers to arrange eye and general health camps for member households. Judging from the crowds we saw that day, it had clearly proved to be very popular.
Tiny as the room initially seemed, it was effortlessly transformed into two areas. The area just at the entrance was divided into a counseling booth on one side and an eye glass dispensation station at the other. Beyond a divider, the vision screening area was set up with Dr. Senthil handling eye inspection and two optometrists measuring visual acuity. By noon, we had already seen more than a hundred patients, nearly all of them women, many middle-aged and some well into their early 70s. As it turned out, patients who had come in earlier in the morning had registered themselves all right, but had disappeared shortly thereafter! And then all of sudden they re-emerged in huge groups creating quite the commotion, as we had started to see patients who’d since registered and made their way through the multiple screening stations.
Trying to regulate the throng somehow and also figuring out what caused this confusion in the first place, we spoke to a few women outside, who were by then shaking their heads and lamenting their lost place in the queue. In the process of inquiring what could possibly have been more important to them than their health, we discovered that the government was disbursing a few thousand rupees in cash for flood- relief to each family. A week ago torrential rains had swept their modest abodes off the ground and had left many of the residents homeless and wet. As many of them worked all day long for daily wages they could not save the few possessions they had. Stunned by the circumstances, we were saddened also to realize that survival required them to make tough choices- food for their infants or shelter for the cold night; Wages to send their kids to school or a health check for their nearly-blind parents? Life is hard. And unimaginably so for the patients we saw. But I was stuck by their un-flappable spirit and their overwhelming gratitude for the littlest of courtesies.
Sobered by the findings we postponed pack-up time by an hour and half. Awash with relief the patients quickly settled into their new positions in line. It left me thinking that there had certainly been room in there for planning the day better if we’d had an inkling as to the government flood relief plans. That said, it is often the case in India, that such things are rarely announced in advance. Even if it were, they would hardly materialize on said date, time or venue! :) Knowing that all we could do was make the most of the time we had left, we plunged into our tasks with renewed vigor.
I volunteered to help with the counseling as I was the only volunteer who could speak fluent Tamil. (My dear MR, spoke a rather sweet and melodious dialect – Palakkad Tamil- spoken in Palghat , which was easily misunderstood for Malayalam; MR & MP opted to observe Dr. Senthil, while P helped Koteeswaran hand out eye glasses and A manned the registration desk.) Many of the patients were semi-literate and were at or about the age of 40 and were starting to suffer from age-related presbyopia. A pair of reading glasses would make a world of difference to their daily activities, such as threading a needle, reading the news, stitching flowers together on a string, separating rice husks and grains, and any number of tasks that require near vision for fine details. It was well worth it to watch as P handed each such patient a pair of glasses to see them flash a wide grin, faces brimming with the joy of being able to read their patient ID card! It was also impressive to see her handle the entire exchange without a word spoken through it all! And yet her gestures and wide eyes spoke volumes as she guided them to try on the glasses and see the difference for themselves…
At the counseling station, Periasamy and I explained to patients what a cataract was and the necessity for surgery to remove mature cataracts to restore their vision. The first few times I simply watched as Periasamy tapped into each patient’s unsaid anxiety and addressed it patiently, emphasizing the minimal discomfort of the procedure and importantly, the fact that it would be provided entirely free of cost to them. I was amazed at how gently he recommended getting the surgery done and yet left the matter entirely up to them in making the decision. (I must confess, I am not sure I mastered that ability to radiate assurance and nor achieve the balance in offering a gentle suggestion versus a firmer one when they insisted upon having a medicine that would cure it all.)
I quickly learned that the one big concern most patients had was how quickly they could get back on their feet post-operation and resume their daily jobs. In fact for some patients, it took multiple sessions of going over how quick and minimally invasive the procedure was and really just how quickly they could get back home. And yet, there would be a lingering sense of apprehension, only assuaged by watching us counsel other patients, assured that we weren’t telling them any different and more importantly seeing them convinced enough to sign up to visit the clinic later that same afternoon for pre-operative consultation. The clinic would send its van back to the camp later that afternoon to pick up such patients to be seen right away and given a date for the cataract surgery. (Those who could not come that very day were given directions to the clinic and its hours and were told to stop by at their convenience.) And on the day of the surgery itself, literally all they’d need was twenty rupees or less to foot their transportation charges to and from the hospital; they could in fact travel alone, if not very old and feeble, a few hours after surgery!
After we’d managed to see all the patients who’d registered up to 1.00pm, the camp organizers had the unenviable task of informing those who straggled in late that they’d have to be seen another day. Some of them had gone to receive the flood relief reward very early hoping to beat the crowd. However, being that there is no such thing as single file in Indian queues that had proved to be entirely in vain, causing them to also miss the eye camps! Thankfully, they were also told that the camps would return within three weeks to the neighboring street and they could certainly avail of that opportunity, at which their protests turned into smiles and they waved goodbye to us, full of blessings and love…

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The ride back to Anna Nagar was quiet; we were each lost in our own thoughts, reliving the hours at the camp, everything we’d seen and learnt. It struck us that despite the excellent material compiled in our training videos, being on the ground and witnessing first- hand the realities therein was an altogether different experience, and a marvelous one at that.

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Filled with an enormous sense of fulfillment and accomplishment and a ravenous appetite, we got off at Hotel Saravana Bhavan, two streets down the road from the clinic. Having promised delicious South Indian meals at student- friendly prices to my famished companions, I was dismayed to find some rather exorbitantly priced Idlis! (Later, I was to find out that we’d been given the tourists’ menu, a version with the prices multiplied by a factor of 5!) Playing the knowledgeable Chennai hostess, I quickly began describing a popular dish to A; ‘It’s like a crepe, you know? Stuffed with potatoes and served with some dips and such…’ and so on. She listened intently at first and then narrowing her eyes exclaimed, ‘Oh! You mean the dosa? I know my dosa!’ Well, that was that then. MR, literally immersed herself in her cream of tomato soup and emerged with an expression of unparalleled bliss from the generous bowl. Indecisive as I am prone to be, after agonizing for minutes on what to eat, I finally settled on Bisibele bhath and musambi juice, only to find that neither was available! Nor were the three alternatives I’d forced myself to decide upon. At any rate, I finally got Sambhar rice and bottled water.
Satiated with lunch, we decided we would explore the area and walk back to the hotel- it couldn’t be that far, besides, we even had a map…right! And so we set out, in our state of food-induced coma, walked for about 15 minutes in what ‘seemed’ to be the right direction, until we realized we were not really getting anywhere. It also struck us that perhaps it was time to open the illustrated map- the map, by the way, was a hand drawn set of squiggles, without any marks for orientation. After putting 5 heads together, we concluded we were still on the right track and the hotel was just a little further down…
Half an hour later, and after 3 stops to get directions, we arrived at the hotel. We had taken one wrong turn, and had gone around and behind the hotel, instead of taking one right turn, literally, and walking straight to it.
Within minutes of arriving, MR discovered that the roof of the room she shared with R, had nearly caved in on one end! We all took turns to stare at the roof that was and collapsed in giggles over how preposterous the whole situation was… And yet I must say, with all the little hiccups and contradictions, noises and chaos, heat and dust, oh! How I love you so, dear India!

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A wonderful first day overall and just the beginning of easily the most memorable and fulfilling of my holidays at home.

I shall attempt to capture faithfully on this blog, in daily journal form, my experience this past December volunteering with Unite For Sight, engaging in service, taking in the sights of Chennai in areas I hadn’t ever visited before, understanding the challenges in delivering health in resource-limited settings, learning about eye care, working with the most giving friends and a tireless staff and the joy of making a small difference…