Dr Tani Brown : Hyderabad

14th May 2015

SICS training is going well. We are expected to get through ~30 cases in the 4 weeks so we do roughly 1-2 cases per day. We operate Monday to Thursday and then Saturdays. I am certainly understanding the respect that needs to be given to a well constructed scleral tunnel. The fellows make it look so easy but it is far from easy. As with all cataract surgery, each step is as important the next and small errors early in the operation can impact significantly on subsequent steps and ultimately the success of the operation. The other concept I have struggled with is the need for a large as possible, but intact, capsulorhexis (peeling the capsule of the cataract - akin to peeling the skin of a grape). As a phaco trained surgeon I have struggled to expand my ‘rhexis’ and at times have had to place relaxing incisions to ensure prolapse of the nucleus does not place undue stress on the capsule and cause a subsequent posterior capsular tear.

Our patients are all from surrounding villages and towns to Hyderabad. The hospital has a very good system for these patient in that they are asked to come the day before to check any medical and ocular co-morbidities and ultimately final fitness for surgery. They are then given free accommodation and board for the night. They are then bused to the operating theatre, and all return later in the day once everyone has had their surgery where they are then given another nights free accommodation and food. The following day we see then post-operatively and they are then given the all clear to go home with strict counselling for drop usage and general care of their eye after surgery. The LVPEI motto is “so that all may see” certainly fits with their ethos of providing free cataract surgery for those who could not afford it otherwise.

As an aside, the states of Telangana and Andhra Pradesh are currently going through intense heatwave. Everyone has been telling me that May is the hottest month for Hyderabad and that the rest of the year has a relatively pleasant climate! Daily temperatures are 47 degrees . Thankfully we spend the worst part of the day indoors in air conditioning but the heat is making going outside unbearable.Unfortunately there have been reports of approximately 2000 people dying, possibly more, from the heat across the two states which is tragic.

I have been trying to do an early morning walk/run in the nearby K.B.R National Park (only a 4 km circuit) for some respite from the traffic and pollution. Even at 6am in the morning the heat is intense but I am grateful for the 40 minutes of exercise. I can definitely see the importance of green spaces for busy and crowded cities. With the reddish dry earth and birdlife, on certain parts of the path if I can almost pretend I am in the middle of no where - the African veld, northern Australia -anywhere but downtown Hyderbad! As an aside my running gear is certainly different to what I wear in Australia with long pantaloon pants and a mid length Kurta and running shoes now my running gear of choice.

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