Editor's note: The Life of Science and Firstpost bring you a series profiling Indian women in Science. The challenges in Indian scientific life are many — more so for women taking up this path. This series honours those who beat the odds and serve as inspirations for the next generation of Indian science — a generation that is slowly and surely on its way to becoming gender equal.
By Upasana Agarwal
Aparna Rao | Eye Specialist and Glaucoma Researcher | LV Prasad Eye Institute, Bhubaneshwar
At the LV Prasad Eye Institute in Bhubaneswar, free clinics offer state-of-the-art facilities. It is here that Aparna Rao, a believer in accessible, community-based health care, is working on finding a cure for glaucoma — among the most mysterious and deadly diseases to affect the human eye.
“I want to learn more, do research that is pertinent to the patient, and give back to the community. I want to be able to guide and help my students grow as researchers,” Aparna explained, when we met her in the midst of her lab work and the last few clinic hours for the day.
At a time when India’s spending on public health presents a worrying future, it is reassuring to see what researchers like Aparna are bringing to the table.
Early years as a glaucoma consultant
Aparna started out as an ophthalmologist (eye specialist) and rose to become a super-specialist in glaucoma. However, being just a consulting doctor for glaucoma became too restrictive. Something was missing. “I was giving the same answers to patients that my professors gave me 15 years ago in medical college. I couldn’t help feel disappointed and frustrated that in all this time, there had been no significant change in the management and treatment of glaucoma. I wanted to give new answers.”
She struggled to find time for research amid her work as a clinician from 2011 until 2014. In 2014, she decided to dedicate herself to lab-based research and signed up for a PhD at the Kalinga Institute of Industrial Technology in Bhubaneswar.
Glaucoma is the second biggest cause of irreversible blindness, with over 12 million cases estimated in India, and almost 60 million worldwide. The disease has reached epidemic levels, but the technology for early detection is limited. In most cases, it is diagnosed at a later stage — after significant damage has already occurred.
Aparna’s research focuses specifically on 'pseudoexfoliation glaucoma', the only type of glaucoma linked to other symptoms in the body, such as cardiac problems and cerebral strokes. On a regular day, Aparna treats around eight to nine patients with pseudoexfoliation glaucoma.
The disease appears as deposits resembling dandruff flakes, in the eyes. The flakes prevent draining of aqueous humour (a watery fluid), raising the pressure in the eye, ultimately causing blindness. Within the glaucoma research community, these flakes pose a significant mystery. Aparna wondered, “Why do only some people develop it and not all? Where do these deposits come from? What genetic and environmental factors are responsible?”
According to her, pseudoexfoliation glaucoma has a very unique geographical distribution — for example, it is concentrated in Odisha, West Bengal, Kashmir, Kerala and Tamil Nadu. “There is no obvious connection between these places apart from their climate and diets,” Aparna said.
First viscocanalostomy in east India
In 2015, Aparna was faced with a challenge. A young boy suffering from early onset glaucoma needed treatment but it would have to be a non-penetrating one. A procedure called viscocanalostomy creates a filtering environment in the eye; excess liquid is drained out through a naturally occurring membrane so that a suitable pressure can be maintained within the eye. A common option in the West, the method seemed suitable for Aparna's young patient. It was the first time the procedure was carried out in east India. Aparna completed it successfully and has since conducted the critical procedure on four other patients.
However, Aparna asserted that emulating global western standards is not always the answer. Most procedures require frequent follow-ups, and this is not always possible for patients in India who stay in far-flung/rural places.
Studying medicine where healthcare is limited
Aparna’s interest in glaucoma comes from a desire to help and serve patients. From 1993-99, Aparna opted to study in a medical college in the town of Ambajogai in Maharashtra. “I wanted to be part of a smaller classroom because I knew it would be more interactive and I would get a better education. Being in Ambajogai, I got to see the real issues that plague the interiors of India where access to healthcare is limited,” she recalled. Such a medical education came at the cost of turning down seats at well-known medical colleges in Mumbai and Coimbatore.
In medical college, Aparna had the privilege of being taught by professors who welcomed her aptitude to explore healthcare deeply. “My classmates and I would go to our professor, Dr Baheti, and he would explain the same topic over and over again to us. All he needed was a cup of tea. Another professor, Dr Das at GNEC, was a true teacher, so difficult to find in today's times. We would go to his office with a bottle of Pepsi or Coke and then he would sit and answer our basic and stupid questions!” she reminisced.
These informal musings with her teachers were a fertile ground for Aparna’s subsequent research career. “Their teaching inspired me to try doing the same for my students. But the student population and their perspectives/priorities have changed as well!” she observed. This is why she feels her current workplace — LVP — is a special platform that nurtures open interactions between students and teachers. Nevertheless, it is a struggle to balance time between research, clinic hours and students, she said.
Time as scientist-cum-doctor
After Ambajogai, Aparna moved to New Delhi to join a diploma course at Guru Nanak Eye Centre at Maulana Azad Medical College. “I was an average student, but with a keen interest in science,” she said. She was mentored by Professor JC Das, who is known for introducing and popularising glaucoma valve surgery in India (a procedure where a valve is used to lower eye pressure). This experience helped Aparna tremendously; while observing the disease, she was also intrigued and disturbed by its permanence.
For the next three years, prior to her PhD, Aparna strove to make it as clinician-cum-researcher on her own. Of the trials during this period Aparna said, “Making breakthroughs was difficult because of the rampant publication rat-race. It has led to a surge in predatory journals in India that operate on a pay-to-publish model and lack a peer review process.” Critics of the ‘publish or perish’ trend in the medical research sphere like Aparna argue that not only does this culture produce less researched work, but it also contributes to a trend of plagiarism and other unethical publication practices.
Aparna rejects the “recognition quotient” — a long-standing belief that recognised scientists do the best science. “These hyper-competitive spaces are less invested in the long-term efforts required to make significant breakthroughs,” she said.
Feeding patient case studies into one’s research seems straightforward. However, Aparna did not have an easy time. “Most of the time, the bandwidth with other researchers did not match. Once a researcher notices that there is something novel to be gained out of the work, they’ll use my idea. Later I’ll find out that they’ve taken it up on their own and continued the work. It’s happened to me so many times,” said Aparna. Instead of becoming negative, such occurrences only prompted her to look for the right people and the right time for starting her work.
Researching an organ like the eye serves up further problems. Aparna explained, “Most researchers are working with the same questions but with different diseases. Because the eye is so small, the tissue to be analysed are also really small and most researchers are intimidated by this.”
When Aparna decided to join a PhD programme, there was resistance from family and colleagues. “I had already established myself as a doctor, so the decision didn’t make sense to everyone,” she said. Nevertheless, she was determined to put in the extra years to set up her research practice formally. “It was what I love… answering the questions that pop into my mind, and so I went ahead and pursued it,” she said. As it turned out, her PhD was only the beginning.
Pushing for change as a glaucoma scientist
Now formally equipped for a research career, Aparna started to apply for grants and began recruiting. She knew that very few institutes would give her time for research at the expense of clinic hours. Fortunately, the LVP platform and work culture allowed this to happen without too many hassles.
Aparna spoke fondly of LV Prasad Institute, where she currently heads glaucoma research. It is a space that allows her to prioritise research by giving her flexible clinic hours. Clinic hours are only half days, and every doctor is given a day off each week for research. “My time at this institute has helped me bridge the gap between clinicians and researchers as well as deliver more integrated education to my students,” she said.
To counter the problem of access and detection, Aparna has been researching easily available methods to spot glaucoma early. Over the last two years, she has developed a detection strip which will work as a tear dipstick assay for easy, cheap glaucoma screening. Simple in form, the strip is based on a principle similar to an over-the-counter pregnancy test. A change in the colour of the strip alerts the user about whether or not they are susceptible to the disease. Aparna anticipates that this will stop glaucoma from causing severe damage before detection.
“On its release, it’ll be easily available to patients and can be distributed in bulk to every home in rural areas by, say, ASHA (Accredited Social Health Activists) workers,” Aparna said.
Among her peers and contemporaries, Aparna has seen that doctors are less inclined to opt for research. She blames the lack of basic research funds around the country and a shift of focus towards popular diseases, which are expected to bring better returns to pharmaceutical companies. “While molecular level research can help towards new medicines and injections, there is little to no significant change in the treatment of the disease. Newer medication produced is more expensive, and treatment isn’t cost-effective,” she added.
In her career, Aparna has made unpopular choices, taken a step back to re-evaluate her role in combating a morbid disease. At 42, Aparna has no regrets. Today, she sits in her lab surrounded by confident, young women researchers who spend their time sampling, analysing and documenting data. She takes her responsibility as a public health scientist very seriously and feels that more effort should be made to bring ophthalmologists and researchers together on one platform to discuss the major obstacles to pursue research that is truly beneficial for patients. "We need to focus on solving problems faced by a patient rather than on the glamour quotient behind every question or research," Aparna concluded. "We need relief from the compelling need to 'perform' for the world."
Read more from the Women in Science series here.
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Updated Date: Jul 20, 2018 17:22 PM