Sonesh Surana
PhD Researcher
University of California at Berkeley

We had a very interesting conversation with this 70-year old patient. We were able to call her in for a quick interview because she lives right next to the vision center. Her nephews are abroad: one in the US (LA region) and another in Saudi Arabia. As a result, she has Internet at home and uses video-conferencing over the web (dial-up) to communicate with them regularly. She wasnt really surprised at the novelty of video-conferencing with the doctor for remote consultation. She thought it was normal.

I: Are your eyes OK?

P: Yes, my eyes are good. Surgery was on 22nd November[2005].

I: Please talk loudly.

P: Around the time of surgery, for about a month, I had to wear glasses and take care. Right after surgery, I had to take rest for a month and only after that do normal things like wash my hair. Now things are good. Once in a while, I feel water retention in the eye that was operated. There is no other problem.

I: You got your surgery done in November ?

P: Yes, 22nd November.

I: So, its been 3 months since youve got operated ?

P: Yes. They put in a lens. My eyesight is good now. But I still have trouble seeing far-away things, but they say I will need glasses for that.

I: What is your name ?

P: G. Ranganayaki.

I: How old are you ?

P: 70 years old.

I: How many people live with you in your house ?

P: My younger brother, his wife, and his 2 sons.

I: Is that all ?

P: No, right now there are only 3 of us: me, my younger brother and his wife. Their 2 sons are in the US.

I: Oh! They are in the US ? Whose sons are they ?

P: They are my younger brothers sons. I dont have kids.

I: So, totally there are 3 of you at home ?

P: One boy is in the US. The other boy is in Saudi Arabia. They are software engineers. The America boy is in Los Angeles, the Saudi boy is in Riyadh.

I: So youre living with them [brother and his wife] ?

P: Yes, I live with them. I was widowed at a very young age. I dont have kids. Ive been living with my brother and Ive known his kids since they were born. Ive known them ever since.

I: So now you live in the next house ?

P: Yes, I live in the next house: Narayana Niketan.

I: How long have you been here ?

P: For 3 years. Sri Narayana Niketan is the address [gives address].

I: Do you work ?

P: No, I dont work.

I: So you simply sit at home ?

P: Yes. I have studied upto 10th standard. After that, I stopped. I was a housewife.

I: They started this center only now, right ?

P: Yes, just started now. About a year, year-and-half back. I have got surgery done in Madurai, so I intended to go there only [for the next surgery].

I: How long ago was that surgery ?

P: 2 years ago. They told me that this place is pretty good too. So I came here for a checkup, to check whether I need surgery or not. They measured my blood sugar and pressure and wrote me a note to take to Theni. They told me I can get surgery done in Theni too and it will be pretty good there.

I: For which eye ? The other eye ?

P: The left eye.

I: Youve already got one eye operated ?

P: That was right eye. This is for left eye.

I: For the left eye did you go to Madurai ?

P: No, only Theni. These people did a checkup and wrote me a note. I took that to Theni.

I: When was the first time you came to the vision center ?

P: For the test ?

I: Yes, at this vision center ?

P: This vision center ? Lets seeI got my surgery done in November. Six months before November, I came here. They asked me to get surgery done then. But due to my circumstances then, I delayed until November [The vision center opened only on Sept 14th, 2005 so 6 months before November is impossible!! Shes probably mistaken].

I: So you got your surgery done 6 months later. How did you find out about this vision center ? Because you live nearby ?

P: This place is doing a lot of good work. There are a lot of really poor people here who find it very hard to go as far as Theni; so its easier for them to come here. Its more convenient for them. They are very caring here and at Theni Aravind. They also provide good service. They treat patients with respect and love.

I: Ok. You know about this place because you live nearby ?

P: Yes. Even I bring in patients now.

I: The first time you came here, you couldve chosen Theni instead. Why did you choose to come here instead ?

P: They told me that if I come here and get a test, they would take me to Theni if needed.

I: Oh, so they told you that after your tests are done, theyll take you there ?

P: They did sugar and pressure test. And then they recommended to the hospital. I said I wanted to go to Madurai but they said Theni was pretty good and that I should go there.

I: So you had not intended to go to Theni originally ?

P: Yes, I intended to go to Madurai. But I needed to get an idea of whether I needed surgery or not, so I just came here for a test to figure it out.

I: Just to find out ?

P: Yes, just to find out. They tested my blood sugar and pressure and said that both were normal, and told me that I could get surgery.

I: Ok. If you didnt come here, you wouldve had to go to Theni. How much harder would that have been for you ?

P: I am old now. Getting on and off a bus is difficult and I would also need somebody to accompany me.

I: Oh, you need somebody to take you there [to Theni]?

P: Yes, I need someone because Ill go all the way to Theni and they will ask me lots of questions there. I will know the answers to some, but I wont know for the rest. They asked me what blood pressure pills I take. I have blood pressure. And I didnt know what they are called. Since my brother was with me, he told them. So, I cannot go there without taking someone along. If I do my first test here, then I can take someone along for the next one. For the first checkup itself, I need someone. But since this is local, it is easier.

I: If this vision center was not here, what would you have done ?

P: I wouldve gone to Theni. Or Madurai. My sisters family lives in Madurai. But since I live here, I wouldve gone to Theni for the tests. It is a 2-day affair. You get the test, next day is the operation, and you can return the next morning. Its very easy.

I: So having this here is convenient for you ?

P: Yes, very convenient. All villagers around here come to this center. They come here for the tests. If operation is needed, they go to Theni. But for other things they can come here itself eyedrops, glasses. When I said my eyes are watering, they gave me some eyedrops. Even my sister-in-law said she had some irritation in her eyes. I brought her here and they gave her eyedrops. One of my sisters also was here. For her, it was her first operation. Her eyes were irritable, and they gave her eyedrops too. Its easy to come and check for small problems here.

I: So small issues can be taken care of right here ?

P: Yes, for operation alone, you have to go to Theni. If you come here [Bodi], they also give you some suggestions.

I: Before you came here, did you know that there is no doctor here ?

P: Yes, I knew.

I: What do you think about that ?

P: They let you talk to the doctor via the computer.

I: Did you know about that beforehand ?

P: Yes.

I: How did you know that ?

P: I didnt know beforehand. When I first came here, the lady told me that this is how it works.

I: You could talk ?

P: Yes. I told the doctor all my problems. He heard it and told me to come for surgery immediately.

I: So before that, you didnt know there was no doctor here ?

P: No, I knew there was no doctor here.

I: How did you have the confidence do come to this place when you knew there was no doctor here ?

P: I thought Id give it a try. When I came here, they told there is a computer here, and that I can talk to the doctor. They told me I could tell all my problems to the doctor through the computer.

I: Who told you this ?

P: That (points) lady told me this. Her name is Chitra.

I: So after you came here, you knew you could talk to the doctor like this ?

P: Yes, that gave more confidence.

I: But how are they going to check ? What are they going to do ? You werent worried ?

P: No, no one was worried.

I: So you didnt have any apprehension ?

P: No, I thought Ill just get a test. For operation, I can go to Theni.

I: So you didnt have any such worries ?

P: No, because Ive already had one operation. I have experience. Also, my brother is a pharmacist.

I: Where is he a pharmacist ?

P: In Theni Government Hospital. My brother told me that theyll only do the tests here. The operation will anyway be done by the doctor. So lets get opinion here and then go.

I: He told you so ? So you came here even though you knew there was no doctor here and you had to talk to him over the computer. What if even this facility was not available ? Would you have come here ?

P: Even then, they will do at least the sugar and pressure test here, so I wouldve come here. This lady wouldve told me if I needed operation or not [generally the nurse conveys the doctors diagnosis to the patient]. And then I wouldve gone to Theni based on that.

I: When you came here, what trouble did you have with your eyes ?

P: I had problems reading letters. I had vision in only one eye. Only if I got an operation, they said I would be able to read well. So I decided to go in for the operation.

I: They told you that here ?

P: You have big cataract. If you operate it, it will be good for you, they said.

I: What other problems did you have with your eyes ? Were your eyes watering ?

P: No. Previously I never had any watering. Only now. I have.

I: Ok. So only your vision was fading ?

P: Yes. I used reading glasses. They told me here, I could continue using them. And I could go for another checkup after the operation. Because, I wear these glasses, I dont have any problems. But 3 months after surgery, my eyes are watering.

I: Lightly ?

P: I came and told his lady and she gave me some eyedrops. She asked me to use them and then come back again. Now, its watering very lightly.

I: Before you came here, for how long did you have this problem ?

P: The eye problem ?

I: Yes.

P: Oh, they told me that when I got my operation done in Aravind Madurai itself [that the other eye also had a problem], about 2 yrs ago. They told me at some point, I will need to get surgery done for the other eye too. They told me that only if I got the other eye operated will my vision be restored. So, I was just trying to figure out when to get it done. So until now, I never got a chance. So then I came here and showed it to them.

I: So you came here ? What are the kinds of tests they did ? How did they do it ?

P: They asked me to read the letter chart. They measured my blood pressure. They also asked me if I have a sugar problem. I said no because I dont have sugar, and so they didnt test my sugar. They said that this [pointing] eye had a problem. So they asked me to go to the next room [the video conferencing room] and talk to the doctor. The doctor spoke to me. I told him its been 2 years since I got the other eye operated, and he asked me to come over to Theni. They gave me a letter here also.

I: So, you spoke to the doctor ?

P: Yes. Even after the operation, the lady asked me to tell the doctor all the problems I had. My eyes were hurting in the glare of the sun. He suggested some medicines and the lady wrote it down for me.

I: So what did the doctor say ?

P: He said everything would be fine if I used these eyedrops.

I: Did it get better after the eyedrops ?

P: Sometimes, there is no problem. Sometimes, there is a problem. Like today, I have some watering. I wouldve had to go all the way to Theni just for this. But now, I can talk to the doctor over the computer.

I: So after you came here and they asked you to come for surgery, and you got surgery, do you feel better now ? When exactly did you have surgery ?

P: 22nd November.

I: So there is no problem after that ?

P: No problem after that. Totally normal. But they asked me to refrain from washing my hair [headbath] for a month, and also be careful about not getting water into my eyes. There is some water retention, and when you have water in the eye it starts pressing on your eyes, right ?

I: So you spoke to the doctor ? How long did you speak to him ?

P: 10 mins.

I: What did you speak about ?

P: Before the operation ?

I: Yes, before.

P: After getting the test done, the lady spoke to the doctor. She told him that the tests were done, Id already had an operation, that there is some cataract in the other eye. Then the doctor told me, this is what the lady says. Do you consent to getting a surgery done ? I gave my consent. He asked me to come to Theni for the operation. Then, people also told me theyd take care and give me a letter which I took with me.

I: Were you satisfied with your speaking with the doctor ?

P: Yes

I: It wouldnt have been exactly like seeing the doctor, and being face to face. So how did you feel talking to him through this ? Did you have any concerns ?

P: No, theyre asking us. I can hear clearly what they are asking me. I am also answering well.

I: Was it a very different experience for you to talk to someone over the TV ?

P: No no. Ive spoken to my boys before. We have Internet at home.

I: So you have spoken to them ?

P: Yes, over the Internet. I have it at home. So this is nothing new.

I: So youre comfortable talking like this ?

P: Yes, this is very normal.

I: Were you satisfied with your conversation with the doctor ? Were you able to convey all your concerns ?

P: Yes, I was to tell him. I had only slight [eye] problems. No other problems.

I: Were you able to see the doctor clearly on the TV ?

P: Yes

I: You were able to see him well ? Did you feel he was able to see you well ?

P: No, there was no problem. I was to hear him clearly.

I: We are substituting the doctors presence here with this because the doctor cannot be here all the time. Do you think this is satisfactory ?

P: For me, this is good. But there are a lot of illiterate, poor people here who would like to have a doctor here. I can manage this without a doctor. But the masses would like it better to have a nice doctor to talk to the poor people.

I: What exactly did the doctor tell you ?

P: He said that the very next day, I can come and get an operation done ?

I: What else did he tell you ?

P: He didnt tell me anything else. The rest I went there and asked and found out. They asked me if I was 1st class, 2nd class, or 3rd class [paying class].

I: Did he prescribe any medicines ?

P: No, he didnt give me any medicines. Only after I went there that night, I was given some medicine.

I:Ok

P: They also gave me some post-operative medicines [in Theni]. Only for this problem (eye watering), I came here and they gave me medicines.

I: Did the doctor prescribe you medicine [at Bodi] ?

P: The lady told the doctor that I have watering eyes and trouble seeing when I go out in the sun. I also said the same thing. The doctor prescribed the medicines.

I: Did you go to Theni again ?

P: No.

I: So you come only here ?

P: Yes, only here. I came here and the lady told me that she was here, so why should I go there, Ill take care of you. If you have any problem, you can talk to the doctor from here. There is no problem with that.

I: So youre vision is good now ?

P: Yes, it is good.

I: So you like the treatment they give you here ?

P: Yes, I like it.

I: Youre satisfied also ?

P: Yes.

I: So you have you told other people about it ?

P: Yes, I have. I have also brought people here.

I: So youve brought your own family members here ?

P: For people who needed an operation, I told them they could get tested her instead. I asked them why they had to take the trouble of going all the way to Theni for a test.

I: So what do you think ? Do you think this video-conferencing is good enough or do you think we should do other things also ?

P: Yes, it will be nice to have a doctor here. I came here, I went to Madurai, and also Theni. The girls who work are very caring, loving, and they never frown. Thats what I like the best about this.

I: What are the improvements you would like to see ?

P: If the doctor is here, it will be nice. Operation cannot be done here. They are taking good care, but then having a doctor would be more satisfying for the masses.

I: Thank you very much.

P: Even now, they are taking very good care here. Do you want to come home ?

I: No, thank you.

P: Where are you from ?

I: Ive come from Madurai.

P: Im also from Madurai originally.

I: Thank you very much for your time.

P: Vanakkam [Youre welcome].