I only have eyes for Kuppam

The next week in Palamaner, Dr. Jacob decided I could use a change of scenery, so he arranged me to go to Kuppam. I wrote this post offline a couple of weeks ago when I was there:

Today (Tuesday, July 8 ) I travelled to Kuppam, a small town about 70 km from Palamaner, where the Emmaus Swiss Eye Hospital is located. The head doctor there is an ophthalmologist named Dr. Olga David. On Tuesdays, they have their outpatient clinic and also admit people for surgery for the following day. Since I have a very light background in anatomy, I didn’t have a very good grounding in the eye or diseases affecting it (my physiology background only really deals with rods and cones and some stuff at the cellular level). But Dr. Olga and the workers and nurses there were very helpful and explained a lot about the eye, eye problems, and the work they do there. Over the week I was introduced to a lot of different conditions and devices that to the untrained eye (i.e. mine, and a slight pun perhaps) closely resembled medieval torture devices. As some of you may know, eyes usually make me a bit squeamish. A. Rita’s eyelid flipping did not impress me when I was young. So some of the stuff I saw this week did make me a bit uncomfortable, but as with everything during this entire trip, I am remarkably able to get over a lot of my squeamishness. (I hope it carries on into the rest of my medical career.)

On Tuesday, a lot of the cases Dr. Olga looked at dealt with cataracts. A cataract is when the lens of the eye stops being completely clear. Sometimes it is cloudy, and sometimes there are small regions that are cloudy or even brown. Cataract also means waterfall, and they have the same word origin. There are also a few people that have glaucoma, where the pressure inside the eye is too high, which can cause damage to the retina. There are both drug and surgical treatments for this condition. The majority of the cases however are people with some sort of refractive error: their eye lens does not focus the image of what they see directly on the retina. They may suffer from myopia (near-sightedness, where you can see near objects clearly, but far images are focused in front of the retina), hypermetropia/hyperopia (far-sightedness, which is pretty much the opposite), and presbyopia, the natural aging and stiffening of the lens which prevents it from changing shape enough to focus on close objects (i.e. reading). They test for these conditions with standard eye tests (i.e. read the following letters), and then also have this pretty cool device, an autorefractor that looks at your eye, and by focusing on the back of your eye, or something like that, it is able to figure out where your eye is focusing, and as such what strength of glasses/contacts you need. I’m not sure exactly how they measure intraocular pressure (pressure inside the eye) in Canada, but here they basically just push a pressure gauge against your eye ball. They also had a device which they pressed against your eyeball which was able to figure out the power of your lens. This is required to figure out what kind of synthetic lens to put in your eye when they replace the lens for cataract surgery.

The next day was surgery. That day there were 7 cataract surgeries followed by two extraocular (not involving the eye) surgeries. The cataract surgeries were pretty quick and followed a kind of rhythm. First the patient has their eye anesthetized so that they can’t feel it or move it. This involved sticking needles into the eye socket area that made me squirm a bit. Once that is all done, they are covered with sheets so that all you can see is the eye. A kind of spreader is used to keep the eyelids back (brought up memories of brainwashing movies where they keep you from closing your eyes, i.e. Clockwork Orange. That picture I think has pretty much the same device). Now one of the reasons I find eyes gross is probably because I see them as being quite sensitive, more like a balloon waiting to pop and spew eye goop everywhere. Not the case at all. Actually the day before, I saw a suture on an eyeball, which I didn’t even know was possible. Anyway, back to the surgery. Dr. Olga then threads some thread through the top of the eye ball, and then clamps down this thread to immobilize the eyeball. With the assistance of a microscope, she cuts around the top of the eyeball, pretty much around the rim of the pupil. In most cases she says she usually cuts into the posterior chamber (I think) to get to the defective lens. Once the incision is made, she sticks in a needle and irrigates the area, loosening up the lens. She then uses a tool to push down behind the lens pretty much squeeze lens out of the opening. I got to see some of the lenses up close after they had been removed. Pretty cool. They were pretty brown and almost opaque for the most part. Reminded me of Ms. Yun-Lee’s Grade 10 bio class when we dissected a cow eye and took out the lens, looking through it. Anyway, after that, Dr. Olga cleans out any other gunk in that compartment, and then inserts a new synthetic lens. She then sutures up the opening with some thread that looked about as fine as human hair, released the holding thread and other instruments, squeezed some antibiotic stuff in the eye and bandaged it. Meanwhile, the next patient has already been anaesthetized and prepped in the adjacent bed, and Dr. Olga can start on that patient. As such, there is pretty quick turnaround, with the actual surgery part taking only about half an hour. It was all very interesting, I am getting over my squeamishness, and once again awed by the resiliency of the tissue of the human body.

After that, the first extraocular surgery involved a young man who had a condition from birth where he had an extra set of eyelashes on his lower left eyelid that were irritating the cornea of his eye. To treat this, Dr. Olga first clamped down on the lower eyelid (a bit squeamish again here). She then split the lower eyelid, cauterized the follicles and then cut most of them out, it looked like. She sewed the lid back together and bandaged him up. After that there was an old man who had a lachrymal duct that was blocked and kept getting infected or something like that, so it had to be removed. She made an incision between the eye and the bridge of the nose, and after a fair bit of cutting and blotting of blood, was able to cut out the lachrymal duct/gland. And so ended a fairly long day of surgery. Very interesting.

The next day is reserved specifically for post-operative checkups, both for surgeries done the previous day, and also those done in the previous 6 weeks. That night, one of the ophthalmology technicians who lives in the quarters here took me around Kuppam. It’s actually fairly large, seems larger than Palamaner, about the same size as Calangute I’d say but less touristy, so fewer clothing shops, restaurants and hotels, but still a lot of little shops and roadside stalls. Managed to even check my mail at an internet cafe.

Friday is another one of the regular clinic days, and my last day. Dr. Olga had some very nice words for me and gave me a bible, in which she wrote a nice message to Dr. Jeff Mascarenhas. That evening I took a train to Bangalore. There were no seats available, so I ended up sitting on the floor, somewhat near the open door where more adventurous people were sitting with their feet hanging out of the train. At one fo the stations, a samosa vendor got on and I decided to take a risk on some possibly sketchy food…they were cold, and egetable, with a little too much cabbage, but at 4 for 10 rupees (25 cents), how can you go wrong? Well it could have gone wrong if I started violently ejecting fluids from all orifices, but luckily that didn’t happen. I got back to Bangalore in one piece, though there was a bit of a disturbance in the area near Nandi’s where apparently some people threw some pigs heads into two mosques which incited a bit of a riot, but it had died down by the time I got back. Apparently this was done in order to scare up some votes in an upcoming election. It’s been almost three months now, and I still don’t quite understand Indian politics. I do know that eveyone is worried about inflation, which is why oil is subsidized here even as prices and demand for oil increase. Predictably, the selectively free market West is not too pleased about these subsidies.

That night I had dinner at Nandi’s with U. Cecil, A. Brinda, Tara and Diya. On the menu, amongst other things, was bheja fry, which up to that point I thought was just the slogan for Indian 7-Up. Turns out it mean brain fry, but in this case not metaphorically speaking. While Nandi pestered me to try some and A. Brinda told her to stop bullying me, I had a very small taste. Not terrible, it had a pate-like texture, but I decided one taste was enough. I’d rather not have any prions running around my body…Speaking of folding proteins, check out Fold It, a project that is trying to figure out how proteins fold by using a human’s puzzle solving intuition rather than an algorithmic way…

Anyway, the next morning, I went with Tara down to Commercial Street, one of the main shopping areas in Bangalore. I was hoping to get a sweet Indian suit, and maybe do some toher shopping, while Tara had to get some last minute stuff done before she headed out to California. We went to a few shops but they were all a bit too expensive. One said I could choose the colour and amount of embroidery, and the weavers or whatever would do something “suitable”, which didn’t really sound that great…But the realy crazy (at least for me) was riding behind Tara on her motorbike through the crazy traffic and roads of Bangalore to get down there. Motorbikes are definitely one of the fastest ways to get around in Bangalore, but as a newbie, I was still pretty scared of falling off. Though once I realized I could hold on to the back, I wasn’t as scared of cracking my head on the road every time Tara accelerated. Childhood memory: Hey Jeff, get in the wagon that you can barely fit in so I can pull you. [as wagon is pulled forward, the handle causes the wagon to tilt upwards, tipping me out so that I crack my head on the ground. But anyway, I got the hang of it, and it was pretty cool. Eat it Joanna. 😉


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