Tuesday, December 29, 2009

driving on outer ring road

For the past couple of months, almost every other day, I have been driving on the new Outer Ring Road circling Hyderabad, and watching the city eat into the rocky wilderness of the Deccan Plateau. I've grown to recognise and in a strange way commune with the large boulders along the road, and each time I notice a new pile of rubble I realise it's one more rock that's found its way into the building materials of the real estate developers. I am amazed at the speed at which the rocks are disappearing into hills of rough gravel, first, and then flattened to make way for the large steel and concrete buildings that will house commerce of various kinds. Profitable, no doubt, and with a logic difficult to argue with.

There's one rock that I've named the Wise Old Man. He has a large forehead and exposed teeth; sometimes it is like he has bared them in a permanent grin, mocking, or just sad. I wonder how much longer he will stand in the way of Cyberabad's expansion. After all, many young families are awaiting plush homes in gated communities, many international schools are awaiting land for spacious new campuses, and of course, there are businesses waiting to be realised.

The Wise Old Man looks on, but he doesn't have too long, I'm afraid. The blasts will sound, the huge cranes will swing, and that smile will soon be wiped off....

Thursday, February 05, 2009

A Story of Villages and Vision

In Peddanandipadu, a village in Prakasam district, at the end of a bumpy, dusty road where cyclists, goats, buffaloes—and the occasional jeep--jostle for space, one suddenly meets a low dapper building with a board prominently featuring the words “Free eye examination”. A clutch of elderly men, some wearing the spectacles that announce the arrival of diminished accommodation, settle comfortably at the base of the steps. Their casual appropriation of the space seems symbolic of a sense of ownership. The Vision Centre, dubbed so because it is a place where people come to regain—with the help of a pair of spectacles—sight once lost, or to seek a solution to something that is bothering their eyes. Inside the room, stepping back into position on the shiny new tiles, a young man in a professional’s white coat puts his display of spectacles in order and walks into his examination room to check a pair of lenses.

Y Srinivasa Rao, the young Vision Technician who has taken over this Vision Centre after a stint in the LVPEI Service Centre in Adilabad clearly knows his job, and those who use his services, like the elderly men at the steps, just as clearly, trust him to take care of their eyes. For us, mostly city slickers from the L V Prasad Eye Institute's ( tertiary centres in Hyderabad,Vizag and Bhubaneswar, this first stop on a tour of self-discovery was both energizing and humbling. Energizing because words and ideas that had only been abstract concepts were now brought to life—quality eye care for all in need at their doorsteps, training human resources for rural eye health—these were not just catchphrases any more, they were real things to real people. Humbling because of the dedication and commitment we could see on the faces of the young Vision Technicians we saw in each of the four centres. The difference they –and through them, LVPEI—make to these rural communities is measurable by the individuals they have been able to help. Y Lalitha, who manages the centre in Parchuru village, described to us how she was able to detect the inkling of a congenital cataract in a six-month old baby and tell the parents to go to the linked service centre.

For the men and woman who work in the paddy fields, the brick kilns, the sugarcane mills and the myriad small industries along this stretch of Coastal Andhra, running from Guntur to Nellore in the south, basic eye care is now within reach. They no longer have to suffer the threat of vision loss because of an injury in the field or struggle to handle their daily tasks because of the lack (and the knowledge of the use) of a simple pair of spectacles. And for more complex needs, the young men and women like Lalitha and Srinivasa know enough to refer them to the service centre that even in the most distant cases is no more than 50 kms away.

The Technicians’ sparkling white coats and the clean counter tops in one Vision Centre after another served to reinforce the idea that quality does not have to be a preserve of the urban corporate hospital, or that quiet efficiency does not have to come at a price unaffordable to the rural poor.

Connectedness to the community was strongly visible in Parchuru village, where the rent for the two room facility was underwritten by four young men, each running a different type of modest business. This type of community “pitching in” took different forms; in Peddanandipadu, it was the donation of the facility in fond memory of deceased parents, while in another village, it was the Panchayat that stepped in to provide space.

Community ownership is what has also made the linkages with the next level of care possible. From Parchuru village, we passed through two more villages (Chinaganjam and Nagaluppalapadu) in Prakasam before we reached the brand new campus of the new LVPEI Service Centre in the small town of Kandukuru. Set in a large and very green campus populated by mango trees in full flower, the Centre is funded by the Ravi brothers of Silicon Valley, and adds to the two other secondary centres that are part of the District Eye Health Initiative. The new team at this centre, led by a Comprehensive Fellow from LVPEI, is all set to begin service delivery. Just after the red ribbon was cut to open the centre, Dr Balasubramanian, Director, Brien Holden Eye Research Centre, LVPEI, filled the first paying patient slot!

After the formal inaugural speeches, a member of the audience stood up and made an offer of space for a vision centre in his village, saying that he would be proud to be associated with LVPEI in this manner.

From Kandukuru it was a short drive in the deepening twilight to Nellore, where within the campus of the Swarna Bharathi Trust, LVPEI runs a secondary centre that serves part of the population of Nellore District. The still-new building, inaugurated in July 2007, has other good works for neighbours—a bridge school for disadvantaged children, a vocational training centre for unemployed youth, and a home for destitute senior citizens. The network in Nellore District is as yet building up, but judging from the enthusiasm of all the stakeholders, this is only a matter of time!

The next morning put us on the road to Madanapalle. From the relative fertility of Nellore, the dry and rocky landscape of this part of Chittoor District was a stark contrast. Forlorn looking tomato vines, fruit sagging and unpicked, were evidence of an unreliable market and its impact on the subsistence farmer. Siloam Eye Hospital suddenly greets you in the middle of this barrenness, its gardens reminiscent of something that has become characteristic of LVPEI hospitals no matter which part of the semi-arid tropics they are!

Dr Shobha not only had laid out an impressive repast for the tired and dusty busload, but had a model eye hospital to show off as well. The inner courtyard, paved with red bricks and its four sectors planted with colourful herbs and cacti, was, she confessed, “laid overnight” by her and her husband Naveen just before the inaugural two years before. Many of the clinical aides were familiar faces, having been trained in Hyderabad. The Centre is also building bridges with the community through an extensive outreach program, screening children and adults in villages on and off the rocky roads of the district. Though cost recovery is an issue in a district as impoverished as Chittoor, the staff of the centre is undeterred in their commitment to providing quality eye care to all, most unmoved even by offers to relocate to more remunerative or professionally productive settings!

Madanapalle provided a perfect end to the tour, encapsulating all the things that LVPEI stands for. Commitment to rural communities that lack eye care and often, even basic health care. Motivation to work in difficult and often demoralizing conditions. And always, an eye on excellence.

On the road to Bangalore, the bus was quiet. We’d covered a large distance, from our comfortable offices in Hyderabad, Bhubaneswar and Visakhapatnam, away from the super-busy surgical and outpatient routines that consume us and often eclipse a sense of the bigger picture, to the fields of Guntur and Prakasam districts and the hills and boulders of Chittoor. We’d also “descended” from the apex of the pyramid to the base, touching and feeling all the levels in between and understanding how they worked together. We were sobered by the enormity of the possibility and also the impact. But all of us, without exception, were also inspired—by the people, the systems, and the vision that had made it all come together.