Just a note to share with our readers:  All is well.

Last night, the official notice came out about the death of Jayalalithaa, Chief Minister of Tamil Nadu, the Indian state where we are spending our visit.  It sounds like she was an incredible — and incredibly complex — woman whose death is shaking the local population.

We are so lucky in being here with our colleagues at Aravind, who are monitoring the situation for us both here and in Chennai for when we fly out. Presently, all our flights are on schedule, and we see no issues with our return flights and itineraries.

We want to share with you a lovely article written by the Grandfather of one of our students.  He is an esteemed statesman here in Chennai, and his article reflects the loss felt by the people of Tamil Nadu.

What an extraordinary trip this has been!

Warmly,

Dawn and Mike

To cover the events of today we must start with events that occurred yesterday. Arun knocked on Tammy and my door around 11PM to see if we were watching the news. Apparently, the prime governor of Tamil Nadu has been in the hospital for several months and her condition worsened last night. The news came out last night that she is on life support. Several of Arun’s family members had called to let him know that we might need to modify our plans for tomorrow because of the political unrest.

This morning everything was still normal in Madurai so we continued with our plans to visit Aurolab, Aravind’s manufacturing facility outside of the city. Just like yesterday we piled into the van and drove through Madurai’s hectic streets to the outskirts of town. We arrived at Aurolab, a large modern facility constructed by Aravind in 2007.

As part of the Aravind Eye Care System Aurolab fits into the overall goal of providing low-cost, high-quality eye care by manufacturing medical equipment. Prior to Aurolab’s development the cost of surgical equipment and pharmaceuticals served as a major barrier to Avavind’s mission. Aurolab solves this problem for the Aravind system and also expands Aravind’s impact by providing equipment and pharmaceuticals both for Aravind patients and patients all over the world, particularly in other Southeastern Asian countries, Africa, and Latin America. For example, the cost of an intraocular lens used in Aravind’s common cataract surgeries was reduced from $200 on the world market to $10 when produced directly by Aurolab.

Although we were not able to take photos inside the Aurolab facility we did get a photo in what Maya called our “Ooompa Loompa” outfits before heading in:

We were lucky to have a fantastic tour guide, a member of Aurolab’s domestic marketing team, to show us around Aurolab’s five departements: intraocular lenses, suture needles, blades, pharmaceuticals, and general equipment. The whole experience felt a bit like being in an episode of Discovery Channel’s “How it’s Made” and we were mesmerized by the process, from the microscopic examination of suture needles to the simple mechanical boxing of eye drops.

What I found particularly amazing about our visit to Aurolab was the way that even in a sterile, air-conditioned setting, far removed from the individuals who benefit from Aravind’s products the same value based motivation we saw in the hospital and vision camp was still present. This was evident both in tour and on a message board created by Aurolab’s employees. As one of the messages said they see themselves as part of Dr. V’s path to providing vision for people all over the world:

When we arrived back at Inspiration House for lunch we received word that our planned visit to Madurai’s Meenakshi Amman Temple was off due to the volatile situation with Tamil Nadu’s governor. Although we are hopeful that we will get the opportunity to tour the temple before we head back to the States we all got some much-needed rest. We napped, watched the local news, and rested up for the final remaining days of the trip!

-Kristen Chalmers ’17

“The vision of what was possible was way beyond what was reasonable”

“It is ourselves we are helping and it is ourselves we are healing”

“ We will have differences. That’s how capitalism works.”

“ We must be efficient capitalists in order to be socialists”

“Intelligence and capability are not enough. There must be the joy of doing something beautiful.”

“This was not meant to be a business model. It was meant to be an ethical model.”

“ To eliminate needless blindness by providing high quality, high volume, compassionate care.”

– Quotes from the welcome presentation by Dr. Prajna (Aravind Eye Care Center)

“We ourselves feel that what we are doing is just a drop in the ocean. But the ocean would be less because of that missing drop,” said Mother Teresa when talking about the importance of doing what one can for humanity. Today, December 1^st, Biology 70 from Dartmouth experienced this quote first hand, witnessing the many drops in the ocean that Aravind was producing.

The morning began early for many of us as the remnants of jet lag allowed us to experience the early morning cool and calm of Madurai. The mosques started their prayers at 5AM over speakers that reverberated throughout the city and the morning traffic ensued around 6AM. We enjoyed idlis and sambar for breakfast at hotel Inspiration before heading across the street to Aravind Eye Care Center. The morning welcome was warm, as the first thing we noticed when walking in was the following sign:

Dr. .Prajna and his two residents welcomed us into a conference room and began an inspirational presentation about Aravind. Dr. Venkataswamy initiated the eye center roughly 40 years ago in Madurai in order to treat those without access to proper eye care (to treat needless blindness). Today their mission is still to “eliminate needless blindness by providing high quality, high volume, compassionate care.” The presentation highlighted that Aravind’s strength lies in being able to overcome the seeming paradoxes in this statement – that is, the eye care center increases quality and compassion with increased quantity. The care center treats over a 1000 patients a day in its two-tiered system. There is both a paying and a free hospital and patients are given the choice to pick one or the other. Dr. Prajna noted that South Indian culture and social norms dictate that those with the money use the paying hospital and those without use the free hospital.

The Aravind system, at this point in the day, sounded more like a Ford factory than a hospital serving an under-resourced area. Cataract surgeries were completed in record time, numbers of patients served were stunning and personnel seemed machine-like in their approach to procedures. Dr. Prajna noted poignantly, “We must be efficient capitalists in order to be socialists,” meaning Aravind seeks to operate justly within an unjust system, by using the volume of patients to their advantage.

Following the presentation, we were given a guided tour throughout the paying and free hospitals. The paying hospital was teeming with patients, nurses in white saris (sisters, as they are known here), doctors in white coats, and all sorts of administrative personnel. The hospital was fully equipped with an in-house bank, a couple of cafés, and many subspecialty departments. The tour was thorough and eye-opening (pardon the pun). The hospital was more like a factory than a hospital, and it was entirely patient-centered. For example, in the free hospital, where most patients are illiterate, patients are given a slip of paper with numbers corresponding to each department of the hospital (instead of names of departments) and nurses help them navigate the vast healthcare system from number to number. Signs were in three to four languages, as Aravind serves not only the city of Madurai but also patients across the state of Tamil Nadu, the country of India and as far as the Ukrainian army.

After our tour, we settled down for a hearty lunch of rice and veggies. We have been eating mostly vegetarian food since arriving in India!  After lunch, we all dived in to our presentations. We walked back over to the eye care center and worked in a classroom all afternoon, perfecting and polishing up our presentations.

We came back through the drizzling rain (it hadn’t rained in Madurai for over 8 months and we brought the rain with us!). Our hotel rooms had a generous helping of mosquitos and, annoyed by their incessant buzzing and bites, we set out on a journey into the streets of Madurai in search of mosquito zapping racquets. We walked through the city like a mother duck and her nine duckings following in a single file line, from store to store in search of the perfect zappers. When we found the zappers that would bring a peaceful night, we paid 720 rupees (about $10.50) for four.  We took an auto rickshaw home and debriefed about the inspirational and exhausting day.

This trip is certainly about our research and presenting our work. But I am learning that if that is all what I take away from it, then I haven’t done my duty. I was born in South India and I went to elementary school here. So, I am at least a bit aware of the difficulty of doing most things in India. It’s hard to get a passport in India without bribing someone and it would seem near impossible to do what Aravind is doing while maintaining its mission. ButI was in disbelief today. Dr. Venkataswamy, the founder of Aravind Eye Care Systems, was told repeatedly “The vision of what was possible was way beyond what was reasonable.” Aravind is unreasonable. The number of patients it treats is unreasonable. Its business model is unreasonable. Its ability to maintain quality of care is unreasonable. Its provision of healthcare to all of Tamil Nadu is unreasonable. This is what is Aravind is about – bringing to reality the unreasonable.

I am so excited by this prospect because I too hope to do what Aravind is doing in my professional career. There is nothing more that I want to see in my profession than healthcare for all. And to see Aravind is to see that it is possible. One day, far into the future, I hope to return to this very country. I hope to create hospitals and healthcare centers that treat millions of rich and poor patients, and ones that change the very landscape of healthcare. For this reason, I am so thankful for this opportunity. Thankful for the people of Dartmouth I am with, for the places we are seeing and for the work we are taking part in.

This was just day one at Aravind Eye Care System. Here’s to a great week. Here’s to many more drops in the ocean this week.

— Arun Ponshumugam ’17

(more photos to come!)

Many blog readers know a little bit about the how and why of this course, but we wanted to bring all our followers up to speed — especially our new ones!

The original course (BIO70) didn’t include any field experience.  Professor Zegans taught the upper level course to mostly seniors, where it consisted of lectures, team literature presentations, and the creation of an NIH-style grant proposal.  In 2015, the team at the Dartmouth Center for the Advancement of Learning began offering pilot funding for undergraduate courses that expanded the teaching to include a clearly defined experiential learning aspect.  Professor Zegans and Dawn Carey moved forward with their Experiential Learning Initiative (ELI) course funding application to cover the costs of travel to southern India during winterim.

The on-campus component of the fall course follows much of the same format and content as the original.  One small change was winnowing the large number of qualified applicants down to the course cap of ten.  With the limitations of travel funding and time, this process allowed the faculty to select students with an appropriately high academic and research background. During the ten-week, on-campus, component, students were introduced to the science side of eye health on a cellular level, along with gaining an understanding of the environmental and behavioral aspects of disease.  In addition, the students attended a required Cultural Navigation class, where they explored some of possible opportunities and challenges found in traveling to a new locale.

The ELI funding also made it possible to host a visiting research scholar from our partner institution, Aravind Eye Care, as another component for feedback and content for the classroom.  This researcher spearheads our scientific conference activities here in Madurai.

Many thanks to DCAL and the ELI for making all this possible!

After almost two days of travel, we safely arrived at the Chennai Radisson, tired but happy.  Somehow, we magically flew during the only two days this week that Lufthansa was NOT striking, so already feeling pretty lucky.

As you can see from the lovely note on our pillows, tomorrow in Chennai promises to be in the mid-eighties for temperature.  After a quick sleep tonight, we will be back on a plane to Madurai in the morning, with temps in the low nineties.  The wee bundle above the note is a small sachet of fresh jasmine — truly intoxicating scent.

Our featured blogger for tomorrow is Caroline, so look for a recap of our first day on the ground then!