Today was an exciting day for all of us, but I"m afraid it didn't lend itself well to pictures, so my apologies in advance.
We spent this morning at the hospital watching surgery. In all, we attended 4 surgeries. Before describing them, I'll note that it is fascinating how the hospital works. Patients report for surgery and are prepped in a very large room. All prep is done by local girls and women recruited from neighboring villages. The "Sisters" take care of the patients every step of the way...literally. They lead the patient into the operating theater, help drape the patient, take care of all of the ancillary details, and lead the patient back to the recovery room. The surgeon, in the meantime, is working at a single station that is next to two beds. As a result, one bed can be cleaned and a patient can be prepared while the surgeon works on their neighbor. This makes for exceptionally efficient process:
The first was an "easy" cataract surgery. The patient is only under local anesthesia, so they walk into the theater and walk out. All of the work is done under a microscope by a surgeon with steady hands, but the process for a cataract removal and an intra-ocular lens placement was 10 minutes! The procedure likely cost the patient $100, and cost the hospital $30. The $70 profit will be used to treat two patients in free hospital who cannot afford surgery.
The second was a more difficult surgery. Due to the patient's condition, the surgeon needed to perform a phacoemulsification. This is a process where an ultrasonic suction device turns the clouded lens into jelly before sucking it out. The new lens is then placed in as with a regular cataract surgery. It took about 15 mintues.
The third was a retinal surgery. With lens replacements, only the outer layers of the eye need to have a small incision. Because the retina is further back in your eye, the surgeon needs to actually put access ports into the eye so that they can extend tools to the very back. It was very interesting to see this. I'm particularly impressed by the ability of these surgeons to handle 70 micron needles and sutures that you can barely see with a naked eye.
The final surgery was an evisceration, and is one similar to the one for which we are designing our implant. This one required general anesthesia. I won't go deep into the details, but the surgeon is sufficiently excited about our project that she had the technical staff change the setup of the operating room so we could all stand right next to her during surgery. The sterile technique in these operating rooms is quite different than what I'm used to in orthopedics, but the infection rate is only 0.03%. That's almost non-existent!
Watching the surgery was exceptionally useful to all of us, because we have a much better idea of the environment where we will be placing the implant, and we recognize what the interacation might be between the surgeon and the device (e.g. handling, suturing, etc.)
We traveled back to Aurolab after the surgery to brainstorm some new ideas, and I met with an engineer to talk about a new project that might be well suited for Thayer School. Then it was back to the guest house for lunch.
On the way, I snapped a couple of pictures. The first is an auto-rickshaw. It is powered by a lawnmower engine, and it completely populates the streets of Madurai. These don't go quickly, especially when they are loaded with re-bar, PVC, a goat, or 11 people (that's the max I've seen so far). In any event. I think they are also responsible for the majority of the traffic. My students got to ride in one today, butI was in meetings all afternoon, so I missed out on this.
Speaking of goats...A whole heard lives in the empty lot across the street, and they come across the street to much on whatever looks good. Usually this is the leftovers from the watermellon man, the sugarcane man, or the leaves that are poking through different fences.
In the afternoon I had two design meetings with a surgeon and an engineer. The current project has stimulated some thought and a potential long-term relationship with Thayer School, and a surgeon introduced me to a very exciting tool that could revolutionize eye surgery. It is simple in concept, and difficult to machine (impossible?). I've written three pages of design ideas to pursue back home, and I hope we can turn around a solution for him. It would be a great student project, and a great way for me to get back to Madurai.
After our meetings, I dropped by the guesthouse to talk with Dr. Zegans, and we headed out to see Dr. Aravind's new clinic. He firmly believes that the Aravind system can be expanded to other areas of medicine, and he is first moving into rehabilitation. He bought a farm about 20 minutes away from the city, and built a full in-patient rehabilitation center on it. The farm is nothing like the city. It was dusk and reminded me of Hawaii. There are mangoes, bananas, and coconouts all around the facility. But to get there we had to battle this huge heard of cows...
The first two floors of the facility have just been completed, and the elevator isn't even installed yet. The architecture will ultimately have two more floors as you can see in the picture. Patients are currently coming from a single neurologist in town, and there is already a waiting list. The target population is stroke and spinal cord injury patients, and the intent is to have them stay for 2 weeks. Occupational thereapy and physical therapy are each offered for 1 hour each day. The facility stresses community, and there are lots of open places to gather. Dr. Aravind visited a lot of hospitals in the United States before designing this facility, and it shows in the architecture. The rooms are very large, even by American standards. The facility is completely accessible, which is unheard of in India...even in the hospitals. The service is designed such that each patient has a private room, and an extra bed for a caregiver. That individual is involved full-time in the therapy process, and dines and works with the patient the whole time. The entire price of this facility, including treatment, food, and lodging for two, is $30 per day. The vision is to make it a new model for rehabilitation, and a step toward moving India to being a more accessible country.
This is the newly finished rehabilitation center.
After our tour, the chef brought out a mixture of coconut, corn, and nuts to eat on this porch. And what snack isn't complete without milk-coffee! Dr. Zegans is in the foreground, Dr. Aravind is looking the other way.
Sunset was very pretty. Despite today being 100 degrees hot, the evening cooled right down and had a nice breeze.
Tomorrow is a transition day for us. We'll go to Aurolab one more time for a final meeting, then we'll start traveling our separate ways. I hope to get a post online at about the same time from Mumbai.
We spent this morning at the hospital watching surgery. In all, we attended 4 surgeries. Before describing them, I'll note that it is fascinating how the hospital works. Patients report for surgery and are prepped in a very large room. All prep is done by local girls and women recruited from neighboring villages. The "Sisters" take care of the patients every step of the way...literally. They lead the patient into the operating theater, help drape the patient, take care of all of the ancillary details, and lead the patient back to the recovery room. The surgeon, in the meantime, is working at a single station that is next to two beds. As a result, one bed can be cleaned and a patient can be prepared while the surgeon works on their neighbor. This makes for exceptionally efficient process:
The first was an "easy" cataract surgery. The patient is only under local anesthesia, so they walk into the theater and walk out. All of the work is done under a microscope by a surgeon with steady hands, but the process for a cataract removal and an intra-ocular lens placement was 10 minutes! The procedure likely cost the patient $100, and cost the hospital $30. The $70 profit will be used to treat two patients in free hospital who cannot afford surgery.
The second was a more difficult surgery. Due to the patient's condition, the surgeon needed to perform a phacoemulsification. This is a process where an ultrasonic suction device turns the clouded lens into jelly before sucking it out. The new lens is then placed in as with a regular cataract surgery. It took about 15 mintues.
The third was a retinal surgery. With lens replacements, only the outer layers of the eye need to have a small incision. Because the retina is further back in your eye, the surgeon needs to actually put access ports into the eye so that they can extend tools to the very back. It was very interesting to see this. I'm particularly impressed by the ability of these surgeons to handle 70 micron needles and sutures that you can barely see with a naked eye.
The final surgery was an evisceration, and is one similar to the one for which we are designing our implant. This one required general anesthesia. I won't go deep into the details, but the surgeon is sufficiently excited about our project that she had the technical staff change the setup of the operating room so we could all stand right next to her during surgery. The sterile technique in these operating rooms is quite different than what I'm used to in orthopedics, but the infection rate is only 0.03%. That's almost non-existent!
Watching the surgery was exceptionally useful to all of us, because we have a much better idea of the environment where we will be placing the implant, and we recognize what the interacation might be between the surgeon and the device (e.g. handling, suturing, etc.)
We traveled back to Aurolab after the surgery to brainstorm some new ideas, and I met with an engineer to talk about a new project that might be well suited for Thayer School. Then it was back to the guest house for lunch.
On the way, I snapped a couple of pictures. The first is an auto-rickshaw. It is powered by a lawnmower engine, and it completely populates the streets of Madurai. These don't go quickly, especially when they are loaded with re-bar, PVC, a goat, or 11 people (that's the max I've seen so far). In any event. I think they are also responsible for the majority of the traffic. My students got to ride in one today, butI was in meetings all afternoon, so I missed out on this.
Speaking of goats...A whole heard lives in the empty lot across the street, and they come across the street to much on whatever looks good. Usually this is the leftovers from the watermellon man, the sugarcane man, or the leaves that are poking through different fences.
In the afternoon I had two design meetings with a surgeon and an engineer. The current project has stimulated some thought and a potential long-term relationship with Thayer School, and a surgeon introduced me to a very exciting tool that could revolutionize eye surgery. It is simple in concept, and difficult to machine (impossible?). I've written three pages of design ideas to pursue back home, and I hope we can turn around a solution for him. It would be a great student project, and a great way for me to get back to Madurai.
After our meetings, I dropped by the guesthouse to talk with Dr. Zegans, and we headed out to see Dr. Aravind's new clinic. He firmly believes that the Aravind system can be expanded to other areas of medicine, and he is first moving into rehabilitation. He bought a farm about 20 minutes away from the city, and built a full in-patient rehabilitation center on it. The farm is nothing like the city. It was dusk and reminded me of Hawaii. There are mangoes, bananas, and coconouts all around the facility. But to get there we had to battle this huge heard of cows...
The first two floors of the facility have just been completed, and the elevator isn't even installed yet. The architecture will ultimately have two more floors as you can see in the picture. Patients are currently coming from a single neurologist in town, and there is already a waiting list. The target population is stroke and spinal cord injury patients, and the intent is to have them stay for 2 weeks. Occupational thereapy and physical therapy are each offered for 1 hour each day. The facility stresses community, and there are lots of open places to gather. Dr. Aravind visited a lot of hospitals in the United States before designing this facility, and it shows in the architecture. The rooms are very large, even by American standards. The facility is completely accessible, which is unheard of in India...even in the hospitals. The service is designed such that each patient has a private room, and an extra bed for a caregiver. That individual is involved full-time in the therapy process, and dines and works with the patient the whole time. The entire price of this facility, including treatment, food, and lodging for two, is $30 per day. The vision is to make it a new model for rehabilitation, and a step toward moving India to being a more accessible country.
Tomorrow is a transition day for us. We'll go to Aurolab one more time for a final meeting, then we'll start traveling our separate ways. I hope to get a post online at about the same time from Mumbai.
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