Orrikai is a little known village near Chennai. In common with the more than 6 lakh other villages of India, medical facilities in Orrikai are poor.

A few monhs ago, the villagers were in for a pleasant experience. A fully equipped ophthalmology hospital on wheels with medical doctors and paramedics visited the village. A thorough screening of the villagers was made. Making use of the spectacular advances in telecommunications, scans and other technologies, test reports were transmitted to the Sankara Netralaya (SN) in Chennai. Expert advice and treatment procedures were tendered to those screened at the camp.

The exercise also helped get a view of the incidence of diabetes, a major cause for eye ailments along with the defects noticed in vision. Those who needed a surgery were brought to the fully equipped tertiary hospital in Chennai, surgery performed and returned to Orrikai. Not merely the treatment; but the cost of other incidentals like food, spectacles, medicines... were provided free.

Hanuman jump in rural eyecare...

Over two-thirds the population in India live in villages with little access to medical aid and qualified doctors. Add to this the increasing incidence of vision ailments afflicting sizable sections of the population. This eye care on wheels veritably marks a Hanuman jump in eyecare for the masses.

Just look at the relief provided: over 2500 camps conducted; close to 10,000 school children screened for vision; around 12,000 glasses dispensed. Over 250,000 beneficiaries!

Sankara Nethralaya pioneered the concept of taking eye care to the rural population through tele-ophthalmology in 2003. The project is presently in operation in Tamil Nadu, Karnataka and Maharashtra. A major fallout is the early detection of vision-threatening complications through diabetes.

The vision and the visionary

In the 1970s Dr. S.S Badrinath, then working at the Vijaya Hospital, had the opportunity to perform a surgical operation on the Paramacharya of the Kanchi Mutt. Later Sri Jayendra Saraswati, the present senior pontiff of the Kanchi Mutt, urged Badrinath and his colleagues to focus on eye care for the masses and lent his blessings.

Dr. T.S. Surendran, vice chairman, Medical Research Foundation and director, paediatrics ophthalmology, SN who has been with the institution since inception, points to the modest beginning of SN with a team of four consultants at the Vijaya Hospital, . The inauguration at the hands of the pioneer Ms. T. Agarwal (of Agarwal group of Eye Hospitals who passed away recently) appears quite auspicious. The small acorn has grown into a mighty oak! Today SN has 85 consultants and 12 sub-specialities under one roof and several firsts to its credit.

A unique feature of SN is that the specialists are all salaried employees! A sense of dedication, passion and involvement on the part of these at the helm appears infectious: witness this across a nearly thousand employees at different levels from the specialists to the front office assistant!

Surendran pointed to the high incidence of eye disorders in India. The paediatric division of SN handles around 23,000 patients (below 16 years) per year. With early diagnosis, a good deal of corrections can be made and a lot of relief provided, he said.

Surendran pointed to the streak of philanthropy spread over vast sections. The sprawling land area of 26 grounds on the College Road was bought from a Parsi couple 30 years ago. C.U. Shah provided the first major funding for the hospital. This was followed by large numbers of others including the renowned jurist Nani Palkhivala.

The requirements are large and continuous. Badrinath, by his sheer personal example and reputation as a brilliant ophthalmologist, has been successful in motivating his colleagues and impressing upon prospective donors to contribute to this great cause. Dozens of leading corporates from the Bajaj to L & T to the Tatas have made munificent contributions. This has helped expand the services across the nation and also to neighbouring countries. SN has been extending its expertise to dozens of other institutions: Sri Ganapathi Nethralaya in Jalna, Maharashtra and Sri Sankaradeva Nethralaya, Guwahati, Assam have been receiving expert guidance from SN.

Over a third of patients from W.Bengal and the east!

Bengali is a familiar language at SN. Close to 35 per cent of the patients come from West Bengal and other eastern states. Surendran recalled the association of the expert ophthalmologist of Bengal, Dr. Murli Sengupta and a great friend of Badrinath, with SN. To serve the region better, SN expanded its operations to Kolkata in association with local Rotary Club. It has screened over 200, 000 patients and performed over 6000 surgeries. Impressed with the need for much wider attention, SN has commissioned a six storeyed new hospital at Mukundpur, Kolkata. This centre of excellence will provide comprehensive eye care.

Similarly SN has expanded into Bengaluru by embarking on a centre of excellence in the garden city.
One is impressed with the fine-tuned systems and efficient procedures that have been perfected. Good recourse to technology and effective hospital management techniques contribute to the ability of SN to handle ever increasing number of patients. Imagine handling around 1500 outpatients and performing 140 surgeries every day!

It’s like the assembly line in an auto plant...

I narrate a personal experience of cataract surgeries, performed almost to assembly line perfection. The procedures have been well laid: an initial screening and tests by experts, fixing the date of surgery and completing other clinical tests beforehand.

Admission on the morning of the surgery, another round of tests and a well-phased passage to the operation theatre taking care of the various tests and procedures. The operation in itself is almost painless and is completed with great efficiency in just about 15 minutes. The patient is kept under observation for a couple of hours and discharged.

The simple bandage is removed the next morning followed by another check up a couple of days later. Detailed instructions on the do’s and don’ts are provided. Care is also taken to make available dark glasses at modest prices (just Rs.50). Cataract operation on the second eye is also done when required with an interval of just a couple of days. And one could resume normal duties, from the third day of surgery!

Dr.Prema Padmanabhan, head of the cataract and IOL services and Director, Refractive Surgery, performs around a dozen surgeries on an operation day. She spends time liberally on pre and post care. Consulting in two adjacent rooms, she examines over a hundred patients every day – all with the same care and attention!

I contrast the pain, the number of days for recovery and the risk involved in cataract surgeries until a couple of decades ago. Padmanabhan points to the complete process from testing to surgery reduced from 6 weeks to 3 days! She points to the advanced techniques and tools available. It was amazing to hear the post- operative infection rate in SN at just 0.01per cent! Padmanabhan pointed to the very small incision, of just 2 mm, made. Also no surgeries are performed on make shift camps; patients are brought to the hospital for treatment and proper surveillance.

Research in latest advances...

Such advances are made thanks to the very close interaction between research and practice. Leading surgeons at SN, including the chief Lingam Gopal, Padmanabhan, Tarun Sharma… have to their credit publication of a large number of research papers in scientific journals and participation in national and international conferences.

A glimpse of the extensive research work done in frontier areas of science was provide by Dr. S Krishnakumar, Head of Ophthalmic Pathology. Kumar has done extensive work in this field and also in nanotechnology, stem cells and treatment of proteomics. Kumar’s work in updating current developments has been of help in orienting the research team in SN to be contemporary. SN works on collaborative research projects in proteomics, nanotechnology, recombinant molecules, retinal stem cells... Kumar said that 1500-2000 retinoblastoma ( a rapidly developing cancer which develops in the cells of retina; Rb has one of best cure rates in childhood cancers) cases are reported every year; work is going on in finding the connection of this disease with cervical cancer. There is evidence of less susceptibility in ceasarian deliveries, he said.

SN is collaborating with IIT- M. IIT -B, CCMB, Institute of Life Sciences, SASTRA , CLRI… and also with the MV Diabetes Centre on tumor biology.

Close study on the incidence of diabetes

The concerns of SN extend beyond diagnosis and treatment. A lot of work is done on health-related social research. Dr.Tarun Sharma,Director, Shri Bhagwan Mahavir Vitreoretinal Services, appeared equally at ease as a social research scientist, as an ophthamologist. Listen to him: “there is an alarming rate of increase in diabetes.This disease affects the eyes, the heart, the kidneys and the nerves. In developing countries, the number of diabetics is expected to increase by 170 per cent in the next 20 years. Diabetes is a serious social issue as it affects people in the working age group.”

SN has launched the Sankara Nethralaya retinopathy programme to understand the severity and incidence of this disease in two phases: “in the first phase nearing completion 6000 individuals over 40 years of age were randomly selected in urban areas. 28 per cent of these are found to be diabetics. Long term complications include diabetic nephropathy and diabetic neuropathy.

“In the second phase, the survey is replicated in the rural areas. In the third phase a performance study and an incidence study (tracking the experience of the people surveyed in the earlier phases) will be done; this will help understand further complications.

“Incidence study and the age-related macular study (study of the loss of vision in the centre of the visual field) are proposed,” said Dr. Sharma. The RD Tata Trust is funding this project. Sharma pointed to advances in diagnosis and treatment like performing an angiogram of the eye.

Technology-driven...

SN is technology-driven. The strong research team at SN keeps abreast of state-of-the-art diagnostic and treatment facilities. Dr. Lingam Gopal, chairman, said that there is no time lag in these areas between developed countries and India: “equipment is regularly updated. Drugs are marketed in India at the same time they are introduced abroad.”
Gopal specialised in vitreoretinal surgery and has written widely on ophthalmic issues.

Gopal said that almost half the surgeries performed at SN are for cataract where a high degree of standardisation and specialisation has been achieved. He pointed with satisfaction to the advances made in India in the manufacture of sophisticated ophthalmic equipment and consumables. Operating microscopes, intraocular lens and the like are produced for domestic needs and exports, he pointed out.

Great fund raiser...

The phenomenal work done by the founder Badinath in building SN to such great heights has been based on tapping resources from far and wide. Socially concious NRIs in the US in particular, help tap the resources of the Indian diaspora. But the needs are rapidly expanding. In the current year alone capital expenditure of Rs 80 crore is to be made. A corpus of about Rs. 30 crore is being built. Gopal feels that funding through donations is not sustainable for meeting the needs of ever-increasing numbers demanding treatment. SN offers diagnosis and treatment free for any one walking into the hospital if his or her income is less than Rs. 3250 per month. In the case of costly treatment that the patient can’t afford, handsome concessions are offered, Gopal pointed out.

Dr Gopal referred to SN working in the emerging area of nanotechnology. This would help treat congenital corneal transplant using stem cells to resurface the cornea, he said.

Over the next five to ten years major concerns will hover around recruiting and retaining qualified and trained manpower. SN’s advantage lies in an excellent connect between medical treatment and research ; the opportunity for advanced academic research attracts young doctors in continuous stream.

The best eye hospital in India - P Chidambaram

SN has won wide acclaim for evolving as the best eye hospital in the country. Badrinath’s passion to provide access to the best of treatment to the poor and the rich alike, on the same measure, was considered impossible for long. SN has done the impossible, testified by such large numbers treated getting it free. The modesty and humility of this pioneer, his passion for service, his ability to tap the needed resources from all and sundry, notably vast sections of the corporate sector and the NRIs and his focus on science and technology are at the base of SN’s spectacular evolution. Surely Chennai is the eye care capital of this country.

- with inputs from Preethi Harinath

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