Recently, I was fortunate to have the opportunity to interview Dr. G. Chandra Sekhar, or Dr. GC as he is popularly known. Dr. GC is Chair of the Operation Eyesight India Board of Directors and Vice-Chair of the L V Prasad Eye Institute (LVPEI), a world-renowned institute and long-time partner of Operation Eyesight. He is an ophthalmologist specializing in glaucoma and a passionate trainer and professor. I learned a great deal during our conversation, and I know our team and supporters will enjoy learning from his experience and expertise, too.

(Note: This blog post was written in March 2021. As has been the case throughout the COVID-19 pandemic, the situation in India is evolving on a day-by-day basis, and the availability of health care services will vary by region/level.)

You have been the Chair of Operation Eyesight India for over 15 years now. What keeps you motivated to serve on the Board, especially considering that it is a voluntary position?

The amount of work that needs to be done to take care of avoidable blindness in the world is huge. As an individual, as an ophthalmologist and as part of the L V Prasad (LVP) Eye Institute, my main goal is to help us achieve this. The connection between the work I do at LVP and the work of Operation Eyesight is very strong, and the program models are the same. As Chairman of the Board, I’m able to facilitate my life’s ambition through Operation Eyesight, which is the reason why I’m doing what little bit I can do. Operation Eyesight teams, in India and other countries of work, are doing a tremendous job. Their values and team effort have kept the organization’s vision going, and I’m happy to contribute whatever I can.

What is your opinion about the work that Operation Eyesight has been doing in India? Do you find any differences between Operation Eyesight’s work and what other international NGOs are doing?

Each NGO has a niche and each of them contributes significantly when it comes to the elimination of avoidable blindness. When I got involved with Operation Eyesight, the organization was going through a change in strategic direction, moving from a focus on volume to a focus on quality. It was around that time when the organization reassessed its hospital partnerships, reduced the number of partners, and supported partners so that they could focus on delivering better quality of care rather than place priority on numbers and statistics. That was very motivating, and I think it was an excellent strategic direction.

As things progressed, the organization moved from a funding agency to a knowledge partner, and that also took off very well. It also differentiated Operation Eyesight from other organizations. In my perspective, both of these changes in strategic direction have been very successful, very meaningful and right on the mark.

This year, Operation Eyesight is continuing its focus on creating access to eye health services. When it comes to eye health services, what are currently the biggest barriers standing in the way of people receiving eye health care in India?

Compared to other health care delivery areas, eye care is probably doing much better. The program models that LVP and Operation Eyesight have created are addressing the barriers to access to a great extent. The major challenge, however, is how much we can replicate our models and expand throughout the country, especially at the primary care level. Another challenge is providing access to secondary and tertiary care closer to people’s homes. The COVID-19 pandemic has fast-tracked the need for this, and LVP and Operation Eyesight are both working to implement solutions.

How has COVID-19 changed the eye health sector in India? How long do you think it will take the sector to function normally?

Drawing from the LVP experience… From the beginning, one of the LVP models has been to take care closer to people’s doorsteps, and we have successfully created a model where we triage the care that is required at the community level. For example, at the primary care level, we have one vision centre for every 50,000 people, and 10 vision centres would feed into a secondary level of care. This model has worked great for us.

During the initial lockdown, patient care at our three tertiary centres dropped to zero. From June 2020 onwards, the care started slowly picking up, at the primary and secondary levels, as well as at the tertiary level. However, the speed with which it picked up at the primary and secondary levels was much more than the speed with which it picked up at the tertiary level.

At this point in time, all levels of care are functioning close to how they were before, but what’s interesting is that the secondary-level care has gone beyond what it was doing earlier. In the past, some people who could access care closer to home would still end up travelling to visit a tertiary centre because of their false sense of quality difference between secondary facilities and tertiary centres. Now, with people afraid to travel because of COVID-19, everyone is accessing care to a great extent at the secondary level. As a result, this level has picked up much faster and has grown much more than what the tertiary level has done.

What are your recommendations to improve access, especially in the rural setting? Can the use of telehealth technology help overcome some of the barriers to eye care?

What COVID-19 has taught us is, if you create an infrastructure and take health care closer to people’s doorsteps, the barriers to accessing eye health care are addressed to a great extent. We need to consider what kind of primary and secondary care, triaging-wise, is required to correct refractive error, give people eyeglasses, treat cataracts, and provide basic screening for glaucoma, diabetic retinopathy and other conditions. We’re assessing this infrastructure and working on technological solutions to provide or enhance these services.

At the primary and secondary levels, if we had the required technology and expertise, we could tell somebody that they don’t need to rush to the tertiary level now, that their disease is in the early stages, and they can take these preventive measures and follow up in six months. We could reassure them and provide the appropriate care closer to home, while referring those in need of immediate attention to the tertiary level. This triaging is a process in evolution for us, and I think it’s getting fast-tracked by the pandemic.

The advantage for ophthalmology is that most of the data we are looking for from a patient can be imaged. It’s a matter of ensuring we have the technology and equipment that is needed to take images of the back of the eye (the retina, optic nerve, etc.), which can provide a lot of information. We need to consider the technology required to gather this information, while at the same time consider how we can connect with people and give them the advice that is required. Innovation is happening on both fronts. We can do video or tele consultations, depending on the patient and the infrastructure available.

Patient-centric medicine is very important. When we see patients and talk to them, we’re able to judge how much anxiety or confidence they have about the disease – especially my specialty, glaucoma, a chronic blinding disease which is asymptomatic. Looking at the patient’s reactions and modulating how we convey the message becomes very crucial through a video consult. If we already know the patient and are giving a follow up, a phone consult might suffice.

There are challenges to consider when it comes to connecting with people, especially in rural areas. Sometimes bandwidth isn’t available. Other times patients aren’t familiar with technology and they don’t have children or someone younger to help them.

If there were one message that you could communicate to Operation Eyesight’s partners and donors around the world, what would it be?

The need for taking care of avoidable blindness and the return for the effort, both by way of dollar and human effort, is huge. The improvements to quality of life and the ability to become self-reliant and productive is probably the maximum with eye care than with other health care needs. Because giving someone eyeglasses and helping them see what they’re doing, or providing them with cataract surgery and returning their vision to normal, makes a huge difference to their total quality of life.  

It’s as simple as that. Once a patient has had their operation and their vision has been restored, within two months they come back to us, and we can see that they have become younger by a decade. 

At the same time, the care that is given has to be quality-oriented and patient-centric without undermining the self-respect of the patient who is getting the care, whether they pay or do not pay. Giving them that respect and delivering quality care is the most important thing that we need to do.  Each individual gets that operation done only once in their lifetime, and each individual has a self-respect that we should not undermine. While we collect our statistics and keep doing all the services that we do, we need to remember the individual, the human being that carries those eyes that we are trying to help. I keep telling my students that we all need to be a good human being first, then a good doctor, then a good ophthalmologist, and then whatever specialty we have taken to be within ophthalmology. We are trying to take care of the community, and that community is actually the individual who is getting the care at that point in time.

Thank you, Dr. GC, for sharing your insights with us and reminding us about the importance of creating access to eye care services closer to the communities we serve and putting people first. There are still many people who need our help, and together with partners like LVPEI and supporters like yourself, we can make great strides in realizing our shared vision of the elimination of avoidable blindness. You are a valuable member of the Operation Eyesight family, and we’re so grateful for your ongoing guidance and support.