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Ophthalmologist weighs changes and challenges ahead
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Govindappa Natchiar, MBBS, DO, MS, had two career choices as a young woman.
 Govindappa Natchiar |
“At the time, the opportunities for girls were to be either teachers or doctors. It was considered to be a divine work,” Dr. Natchiar said.
She chose to follow her oldest brother’s lead and begin a career in medicine — a move which continued her family’s legacy of serving the people of India.
Brother and mentor
Dr. Natchiar is currently the vice chairwoman, a professor of ophthalmology and the director of the human resources department of the Aravind Eye Care System and Postgraduate Institute of Ophthalmology, Madurai. She graduated from medical school at Madras University in 1965, initially wanting to specialize in pediatrics. However, Govindappa Venkataswamy, MD, her oldest brother and founder of the Aravind Eye Care System, persuaded her to specialize in ophthalmology.
“At the time, ophthalmology was not as well-known as it is today,” she told Ocular Surgery News Asia-Pacific Edition in a telephone interview. “Dr. V. felt there was a huge need for ophthalmologists, and he called me and said that if I didn’t become an ophthalmologist, who else could he convince to be an ophthalmologist. So that is how I became an ophthalmologist.”
She said her brother, who died in July 2006, was her greatest teacher and mentor.
“He was a leader, thinker and an amazing person. He trusted us, which gave us great courage and experience to manage the institutions,” Dr. Natchiar said.
Her family connections continue today. She works with her husband, Perumalsamy Namperumalsamy, MS, DO, FAMS, chairman of Aravind Eye Care System, as well as 15 other family members who are ophthalmologists at the institution.
“It is kind of like a baptism. Make one person an ophthalmologist and [then] that person makes another person an ophthalmologist. It goes on and on,” she said.
Training programs
Dr. Natchiar started her career in ophthalmology as an assistant surgeon in the eye department of Government Erskine Hospital in Madurai and became assistant professor in neuro-ophthalmology at Madurai Medical College.
Since 1993, Dr. Natchiar has been the director of the IOL microsurgical training program at Aravind Eye Hospital in Madurai in collaboration with Royal Commonwealth Society for the Blind, U.K. Under this program, residents from India and other developing countries have trained in IOL surgery and phaco surgery.
In collaboration with the government of India, she started a program in which candidates are trained in microsurgery for a 2-month period. She is also in charge for the training in paramedical and nursing staff at Aravind Eye Hospital.
Making eyes sparkle
Dr. Natchiar said throughout her 40-year career, ophthalmologists have had to tackle blindness in India. However, she has found the work rewarding because it has provided her the opportunity to give patients back their vision and, ultimately, their lives.
“When you remove the bandages [after cataract surgery], their eyes sparkle,” she said. “What happens in their face cannot be explained. It is as if you are giving them their whole life. The whole darkness in the world is taken away by a bright light.”
She said her work also provides happiness to the whole family. She has seen economic situations improve, depression disappear, a patient’s movement become more vibrant and mobility become stronger.
“You are giving life to the patient. When a person becomes blind, all his movements become crippled. So he is not only blind, but also he seems unwanted and depressed. [Ophthalmology] pays your rewards right now. You don’t have to wait for your blessings in heaven,” Dr. Natchiar said.
Test of time
Dr. Natchiar said ophthalmology has changed in India throughout her career, and she considers herself lucky to have seen a number of changes.
During her early years as an ophthalmologist, the problem of blindness due to cataracts was serious in India. Treatment was limited to removing the lens, then providing the patients with thick glasses to wear. She said it was not great, but the patients could see and were happy.
“But today, cataract blindness is coming down because of more providers and the standard of treatment are good,” she said.
The introduction of IOLs in India during the mid-1980s was an expensive surgical option, for which “a common man could not reach, so we were doing [IOLs] for paying cases only,” Dr. Natchiar said.
In 1992, Dr. Venkataswamy started Aurolab, the manufacturing division of Aravind Eye Hospital, to produce high-quality ophthalmic consumables at affordable prices to developing countries. Aurolab has supplied more than 7 million lenses to its customers in India and more than 120 other countries worldwide, she said.
However, Dr. Natchiar said even though technology has improved the quality of surgery and the patient’s quality of vision, it also has changed the patient’s expectations.
“Years ago, following IOL surgery, patients would stay for 7 days. Now they are home within hours,” she said.
Next epidemic: diabetic retinopathy
Dr. Natchiar said the next challenge facing Indian ophthalmologists is treating the increasing numbers of patients with diabetic retinopathy in light of the emerging epidemic of diabetes in the country. According to the World Health Organization, there were 31.7 million people with diabetes in India in 2000. This number is estimated to increase to 79.4 million by 2030.
“Diabetes was earlier seen in patients in their 50s and 60s. However, now you see patients with diabetes in their early 40s,” Dr. Natchiar said.
Unlike blindness due to cataracts, she said, diabetes is a chronic, multisystem disease, and ophthalmologists will have additional challenges in treating diabetic retinopathy. Those with diabetes are 25 times more likely to develop blindness.
“In one way, you are happy because you cured cataract blindness. But [in another way], the emerging problem of diabetic retinopathy is going to be a big challenge because unlike cataracts, it cannot be cured with one treatment,” she said. “The other problem with this condition is the patient will not be aware that he/she is affected in the early stages unless they go for a checkup with the ophthalmologist. It is a chronic condition, and the management is going to be expensive for India. The economic burden can be reduced if we take active steps to prevent this needless blindness by early screening.” — by Kristine Houck
References:
- Pradeepa R, Deepa R, Mohan V. Epidemiology of diabetes in India: current perspective and future projections. J Indian Med Assoc. 2002;100(3):144-148.
- Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27(5):1047-1053.
- Govindappa Natchiar, MBBS, MS, DO, can be reached at Aravind Eye Hospital, Madurai, 1, Anna Nagar, 625020 India; +91-452-5356100; fax: +91-452-2530984; e-mail: g.natchiar@aravind.org.
