Annual Report 2020
• Advancing optic disc drusen research
• Cross-department team effort
• Vision restoration in glaucoma
> A global career path
• Pursuing excellence through diversity, equity, and inclusion
• Advancing clinical research in the age of COVID-19
• Improving ophthalmologic care through artificial intelligence
• Solving corneal blindness with implantable video technology
A global career path
Health equity and female empowerment
Byers Eye Institute at Stanford chief resident Malini Pasricha, MD, grew up in the United States, but whenever visiting her ancestral home in Rayavaram, Tamil Nadu, India, she was often struck by two major disparities: limited access to healthcare and minimal career opportunities for women.
Rayavaram is a village with unpaved roads, limited access to running water, and frequent power outages. Previously, the entire region did not have a single eye clinic to serve its 1.5 million residents. Most residents bore the burden of their eye diseases indefinitely; in cases where they elected to seek care elsewhere, the cost of transportation and lost wages due to time spent traveling added additional burdens.
Additionally, in the community, women rarely pursued higher education and career advancement. Most were married at a young age and dedicated their lives to homemaking.
Pasricha had an idea for how to solve both of these unmet needs head-on: start an eye clinic locally and educate and encourage women to staff it. The first major hurdle to cross was finding a place to develop such a clinic, but here her grandparents stepped in to help by offering to donate their ancestral home in Rayavaram.
“My grandmother had told me many times before that she wanted to use our home to serve a greater good,” Pasricha said. “She brought an incredible energy to the initiative and was eager to support at every step of the way.”
Measuring the need for eye care
The seed of Pasricha’s interest in eye health disparities started growing the summer after graduating high school, when she traveled to India and attended an eye appointment at the local hospital with her uncle, who has diabetic retinopathy. Noticing her youthful curiosity, the ophthalmologist invited Pasricha to stay for the day to observe. That day, Pasricha was struck by the number of patients presenting with eye diseases that were immediately treatable or preventable if detected at an earlier stage. She felt inspired to pursue a career in ophthalmology to address eye disease worldwide.
Focused on better educating herself on global health, Pasricha entered her freshman year at Duke University, where she designed her own major, titled Global Health Disparities and Development Strategies. She identified effective principles for improving eye care accessibility in another country, one of which was sustainability. For this she knew she would need to partner with a local hospital for clinical staff support. She also envisioned a care model that would charge a nominal fee to cover basic maintenance, supply, and staffing costs, such that the facility could function independent of external funding and leftover supplies.
In 2012, as Pasricha began medical school, she sought a clinical partnership with the Aravind Eye Hospital, a prestigious national eye health care system with a flagship facility located a two-hour drive from Rayavaram. Over the next four years, she planned and executed several one-day eye camps in Rayavaram, where patients could undergo vision screening and counseling in their local area. Setting up these camps required securing grants and supply donations from U.S.-based organizations, establishing a partnership with the local government and community college for non-medical support and volunteers, and publicizing these opportunities for care in a mostly illiterate population.
The initial response was overwhelming. With hundreds of patients treated at the eye camps, her work confirmed the community’s need and desire for eye care services.
Building female leaders
As hard as it was to operationalize eye care in this impoverished community, Pasricha also found herself up against an equally formidable challenge as a young woman trying to effect change.
“My two sisters and I were raised by my parents to be strong, independent women,” Pasricha said. “I remember visiting Rayavaram at the beginning of this project with big hopes, but instantly felt small and invisible. The culture was not readily welcoming to me as a woman trying to move the project forward.”
Though disheartened at first, Pasricha turned these feelings into fuel for change.
“We needed to create female leaders within the community,” Pasricha said.
Pasricha and her grandmother visited the local high school to recruit women who had the potential to pursue health technician training at the Aravind Eye Hospital. They identified five young women, met with their parents to discuss the value of such training, and promised subsequent employment in the eye clinic or other Aravind-affiliated eye clinics in the region. All five completed their training and moved into new roles providing eye care.
“Now these women are seen as pioneers and role models for the women in the area,” Pasricha said.
The final countdown
After eight years of hard work, the Aravind Vision Centre of Rayavaram opened its doors in January 2016. The clinic now operates six days a week and is staffed by two female eye health technicians. The facility is stocked with state-of-the-art equipment and supplies, and operates with an electronic medical record system, broadband internet, and daily cleaning staff. Visits are affordable to the local community (the equivalent of 25 cents in U.S. currency), and an onsite optical shop adds access to needed eye care while also offsetting the clinic’s basic functioning costs. In an effort to promote prevention-based care, the primary role of one health technician is to educate patients about their eye health. An ophthalmologist stationed at the main Aravind Eye Hospital also tele-consults on every patient via webcam.
Pasricha has worked tirelessly to bring this to fruition, but she is first to credit those who helped her.
“I really have to thank my grandmother for being a driving force behind this.,” Pasricha said. “She barely completed twelfth grade, but her courage and giving spirit are inspiring.”
Pasricha tries to visit the clinic as often as she can, most recently in January 2020, to continue to improve and expand the clinic. Clinical data is collected on an ongoing basis to help quantify successes and identify areas for improvement.
“The Aravind Vision Centre of Rayavaram is a reflection of two broad goals I am most passionate about: health equity and female empowerment,” Pasricha said. “As I move on to pursue a training in vitreoretinal surgery, I hope to focus on improving access to retina-related eye care in developing countries and continue to find ways to support women in becoming accomplished health providers.”
By KATHRYN SILL
Kathryn Sill is a web and communications specialist for the Byers Eye Institute in the Department of Ophthalmology, at Stanford University School of Medicine. Email her at email@example.com.