Reflections on Volunteering in India

By Anushka Das
Tulane University Student
Global Impact Fellow

Introduction

When I arrived in Dhenkanal, the first thing that I noticed was the blur of purple outfits that I would see darting from room to room, escorting patients, carrying files, or conducting visual acuity tests. From six in the morning till the late hours of the evening, the paramedics of Kalinga Eye Hospital do not operate within business hours. Every waking minute is dedicated to the hospital and to the patients. From ages sixteen to early thirties, this diverse group of women work tirelessly to ensure that each patient that sets foot in the hospital receives proper, quality medical treatment, which is a difficult feat for a hospital located in rural India that is working with limited resources. Yet Kalinga Eye Hospital has transformed into a systematic, efficient machine with a sustainable revenue-generating model that continues to fund thousands of cataract surgeries. Though I was only there for ten days, I don’t think I can say at any point I saw a dissatisfied patient. From my conversations with the ophthalmologists, lenscrafter, optometrists, and even the receptionists, one thing is sure: the paramedics serve as an integral component to the hospital’s massive success.

As I was receiving my introductory tour, I was astounded at the pace of the hospital. Having visited India many times, I was accustomed to the typical laid back manner in the country (from governmental institutions to restaurants). Even receiving my order for a Diet Pepsi was subjected to the mood of the waiter and whether he “felt” like putting my order in. However, I remember being pleased to see the paramedics go about the hospital with a sense of urgency. Yet they still managed to maintain composure when explaining to the patients from rural villages what their medical ailments meant. While watching Dr. Nanda perform a routine checkup on a paying patient, I noticed how the paramedics expedited the entire process, revealing Kalinga’s secret to churning out impressive statistics on patients served. The paramedics served as a right hand to Dr. Nanda, allowing him to wrap up the checkup within five to seven minutes. Within fifteen minutes, the patient had visited the pharmacy, picked up his prescription, and was riding away into the sunset on his motorcycle.

Role

The role of the paramedics extends to more than just visual acuity tests and general checkups. They are in every corner of the hospital, from the operating room to the pharmacy. Their widespread knowledge comes after years of intensive training.

The role of the paramedics’ can be broken down as follows:

Another way I could gauge the importance of paramedics was by following a patient through the entire process. The patient first walks through the pristine doors of the hospital to the receptionist desk for registration. They then wait for usually a brief moment before being escorted to the vision room for a visual acuity test. The patients then see one of the two ophthalmologists for a check-up. Afterwards, they enter the adjoining refraction room, and the paramedics are trained to look for:

  1. Conjunctivitis, corneal ulcers, glaucoma, and retinal problems, which they can usually treat with prescribed medicines available in the stocked pharmacy if these are the less severe cases.
  2. Problems in the anterior segment of the eye (conjunctiva, sclera) that usually manifest in cataracts, or in the posterior segment which they then refer on to another checkup looking specifically for problems in this part of the eye.

The Bigger Picture

For future volunteers, I highly recommend making the time out to meet Dr. Nanda, the chief ophthalmologist. Dr. Nanda was a doctor for India's military for over twenty years, and he is one of the most inspirational people I have ever met. Whether it’s debating Obama’s fiscal policy to explaining why we get pink eye, Dr. Nanda is extremely well informed. After a chai break one afternoon, he discussed the importance the paramedics play in not just Kalinga, but a nationwide effort to reducing the number of cataracts. Much to my surprise, the number of cataract cases in India is actually rising. However, the problem isn’t some mysterious disease inducing cataracts, it means patients are coming forward/actively seeking out treatment themselves. Dr. Nanda discussed how post-operative disasters by makeshift camps that visited once every two years would fail to treat the patient after the cataract removal and permanently damage the patients’ eyes. Now, India banned these types of programs, and patient confidence is on the rise. Better healthcare means more surgeries. Improving detection methods with the latest technology, as well as raising the bar for the surgeries, are some of the many ways that Kalinga has been increasing patient interest. Nonetheless, more patients means that they need more healthcare professionals. That’s where paramedics come in. Not only are these paramedics capable of performing many tasks ranging in complexity, they empower the communities by placing women in a high demand job requiring expertise. Moreover, for the conservative villages, when time comes for the women to get married and return, they bring back this crucial knowledge to their village and serve as healthcare ambassadors.

From a School Girl to a Paramedic

As I got to know the paramedics better every night, I realized that their journey to the hospital in itself was a huge accomplishment. Many delayed arranged marriages to come work for a few years before they were required to return to their village as a housewife. Their desire to learn and to make a difference left me awe-struck. As a college student, homework remains the bane of my existence. There, I befriended Uma, a seventeen-year old junior paramedic, who stayed up late every night poring over any reading material she could lay her hands on detailing ocular diseases and modern techniques for the refractions and diabetes tests she conducts.  Every night, Uma and I would sit down for English lessons in exchange for Hindi ones. I got to know her very well during my stay, and she detailed her journey up to Kalinga. Uma grew up in a small town where her older brother was her best friend. Her fondest memories include her brother speeding down the main road on his bicycle in the rain, hand-stitching her own doll, and practicing for singing competitions in her high school. When some of the paramedics would become lost in the hectic rush of the camps, Uma would always maintain the bubbly smile and drop a few jokes to ease the patients. She was the little sister to not only the paramedics, but for many at the hospital. For Uma, coming to Kalinga was her opportunity to justify the life she would lead eventually. Ten years down the road, she says the satisfaction and experience of helping thousands of blind men and women will be enough to keep her happy for the rest of life. Meanwhile, her goal is to maximize her impact, and she recognizes that doing whatever she can to reach the senior paramedic echelon quickly will achieve this.

Another paramedic I befriended, Lippi Didi, also shared the same perspective. Lippi was considerably older than Uma, and as many of the other paramedics joked, her time for marriage was running out. I asked Lippi about her contrasting life in the village and in Kalinga. She explained how, at first, she was distraught leaving her family to take on a job that she knew nothing about.  Lippi recalls struggling learning to memorize the countless instruments. Though it took her a while, she now trains the junior paramedics. She credits her paramedic friends who guided her throughout the entire training process and provided a safety net. “This is my family now!” she exclaimed before breaking out into song and tango with a sister paramedic. Lippi acknowledges that she has traveled to so many new places and met people from different walks of life that have molded her own take on things. Finally, on the other spectrum, Sasmita Didi was preparing to leave her job as a paramedic with her upcoming marriage. As she showed me the card her fiancée sent, she expressed how torn she was to leave the hospital.  She explained that despite being excited to start her new life, she would struggle breaking from her regular routine at Kalinga. From the fellow paramedics becoming her little and big sisters, to the demand of her role as a paramedic, Didi couldn’t help but tearing up. “Kabhi khushi kabhi gham!” she exclaimed, wiping her tears, referencing the famous Bollywood movie whose title translates to “Sometimes happiness, sometimes sadness.”

Conclusion

My time at Kalinga Eye Hospital, as short as it was, proved to be eye opening and inspirational. Eye opening in the sense that I realized that healthcare complexities in developing countries entailed more understanding and cooperation than I envisioned. Inspiration seeped in during times when I would see the patients undo their cataract bandages to see clearly after a long spell of blurry vision. The entire system in which the Kalinga Hospital operates with support from Unite For Sight increased my appreciation for their effort and literally the blood, sweat, and tears that goes into making the hospital operate on a daily basis. I would recommend the Global Impact Corps Program any day, and I thank Unite For Sight and Kalinga Eye Hospital for making this journey possible. Last but not least, I thank not only the paramedics in Kalinga, but paramedics everywhere in remote areas like Dhenkanal whose courage to leave home and become a paramedic are motivation for everyone out there trying to make a difference in the healthcare field.