Parvesh Konda
As I started the day meeting a patient living with advanced cataracts in both eyes, I was struck by the life-altering impact of vision loss. This defining moment underscored the invaluable role of accessible ophthalmic care, a reality I witnessed first-hand at the Railway Hospitals of Madurai, India. The Railway Hospitals of Madurai, India, provide a captivating setting for an elective experience abroad.
The Railways Hospitals in India cater primarily to railway employees, their families and retirees, providing various speciality medical services. With 695 branches nationwide, they provide essential healthcare mainly to a vast workforce employed by the railways network. During my short elective experience in Tamil Nadu, a southern state in India, I had the privilege of observing healthcare delivery at one of these institutions. The hospital provides outpatient, inpatient, emergency, and speciality clinics. My experience focused primarily on shadowing a consultant Ophthalmologist, which proved enlightening and inspiring.
As the most populated country in the world, India faces a massive burden of visual impairment and blindness. In addition to the effect on quality of life, this also creates a huge financial burden– estimated to contribute to a net loss of gross national income of approximately 38.4 billion USD (1, 2). With an increase in modifiable and non-modifiable risk factors such as diabetes and an ageing population, the number of people living with visual impairment or visual loss is predicted to grow. Results from a Rapid Assessment of Avoidable Blindness (RAAB) done in India have demonstrated that one in four individuals over the age of fifty are currently living with visual impairment in India due to cataracts (66.2%), corneal opacities (8.2%), cataract surgery complications, and others (3).
This trend was also true in divisional railway hospitals. In addition, anecdotal evidence suggested workplace-related injuries included trauma, foreign body injuries and chemical injuries. A detailed literature search was carried out to investigate the common ophthalmic presentations to Railway Hospitals however no evidence on this demographic was found. This provides an important area of investigation that may help further inform resource allocation in the future.
During my experience, I observed firsthand the use of ophthalmic tools including retinoscopes, keratometer and head-mounted indirect ophthalmoscopes. This helped to underscore the technological leaps in ophthalmic imaging including innovations like OCTA and AI in retinal imaging. In addition, by encountering patients with advanced cataracts and severe retinopathy, I was able to appreciate the massive importance of visual and diabetic screening programmes such as those in the UK (4).
Madurai is known as the ‘City of Temples’ and has over 30 historic temples dating back to the 6th and 7th centuries and is also celebrated for its vibrant culinary scene for example the famous sweet drink – Jigarthanda. From a medical viewpoint, Madurai is the birthplace of the renowned Aravind Eye Hospitals, founded by Dr Govindappa Venkataswamy. It is now one of the largest eye hospital groups in India treating 32 million patients to date and performing 4 million surgeries while training future ophthalmologists in the latest treatments and techniques.
My connection to this opportunity stemmed from a relative in a nearby city who introduced me to the consultant ophthalmologist at the railway hospitals. Nonetheless, there is the opportunity to reach out and organise these experiences by emailing relevant medical directors in charge of railway hospitals.
If you are interested in Ophthalmology, eye hospitals in India provide an interesting and unique take on medical practice that can help develop a broad understanding and an appreciation of the different public health targets in other parts of the world.
Acknowledgements
I would like to thank Dr Vimala (Additional Chief Medical Superintendent) at Railways Hospital for this opportunity.
References
- Projected Change in Vision Loss 2020 to 2050 [Internet]. Projected Change in Vision Loss 2020 to 2050. Available from: https://www.iapb.org/learn/vision-atlas/magnitude-and-projections/projected-change/
- Mannava S, Borah RR, Shamanna BR. Current estimates of the economic burden of blindness and visual impairment in India: A cost of illness study. Indian Journal of Ophthalmology. 2022 Jun;70(6):2141–5.
- Vashist P, Senjam SS, Gupta V, Gupta N, Shamanna BR, Wadhwani M, et al. Blindness and visual impairment and their causes in India: Results of a nationally representative survey. Eppig T, editor. PLoS ONE. 2022 Jul 21;17(7):e0271736.
- Singh R. Commentary: Diabetes eye screening in India. Indian Journal of Ophthalmology. 2022 Jun;70(6):1957–1957.