The Third Eye
Sitting Down With… Ashiyana Nariani, Cornea and Refractive Surgeon, Ocular Oncologist, and Assistant Professor in the Department of Ophthalmology at King Edward Memorial (KEM) Hospital and Seth G.S. Medical College, Mumbai, India
Aleksandra Jones | | Interview
Who inspired you to move from the US to India to practice ophthalmology?
When I was growing up, my biggest dream was to serve the underserved. As a young girl, I met my spiritual mentor, Dada J.P. Vaswani – a figure famous for dedicating himself to the service of humanity – and he became an example for me to live by. He lived in complete humility and compassion, giving himself to each and every person. Dada Vaswani showed me that we have one life and we should make the most of it by serving other humans and taking care of animals. Another hero of mine is Albert Schweitzer, a Nobel Peace Prize-winning physician who left his life in Europe to serve patients in Africa. When I was in medical school in Boston, doing my Master’s degree in Public Health, I came across the Albert Schweitzer Fellowship of Service and I was inspired to work in clinics for the local underprivileged population.
Tell me about moving to India...
When I finished my corneal transplant fellowship at Duke University, I had to choose between a career in academia in the US or helping the underserved abroad. I had several positions open to me in the US and no job lined up in India – I didn’t even have a license to practice here. Nevertheless, I moved here in 2018. I started writing to the chief ministers and medical council bodies, who weren’t sure what to make of me – they had never known a US doctor to move to India. I worked hard to explain that I came to work for those who needed my help – to reverse blindness with cataract surgery or a corneal transplant.
I went up the ranks of ministers, attending meetings, calling, and emailing. Eventually, I ended up at the top, explaining to Prime Minister Narendra Modi’s government that my intentions were pure and I wanted to do things based on merit – not money under the table. Finally, I was sent to New Delhi to meet the Head of the Medical Council of India, who apologized to me for all the delays – and that’s how I got certified to work in India. It has not been a straight path, but I am so happy to be working and living here. I never thought this is where I would end up, but I followed my intuition and my beliefs.
Where are you based now?
I got a faculty position at the Municipal Hospital in Mumbai. I normally see between 100 and 200 patients a day – this has been reduced to70 or fewer patients a day during the pandemic. These patients don’t have any money to pay for treatment. Their procedures are free of charge, but they are normally required to pay for the supplies. Unfortunately, 49 rupees (less than a dollar) for a bottle of steroid drops is often out of their reach – so we often pay for their lenses or medication ourselves.
Have your colleagues been supportive of your choice?
My colleagues and friends said, “We know you want to do humanitarian work full time, but can’t you wait until you’re 65 and retired, with plenty of money in the bank?” The thing is – I have no guarantees that I am going to live that long! I don’t know what’s going to happen tomorrow. Even Amar Agarwal, a great friend of mine, tried to dissuade me. Nevertheless, I think I persuaded everyone that this was my trajectory in life – and I hope that other people can use me as an example.
These days, my US colleagues help me with fundraising efforts for basic equipment, IOLs, chemotherapy for ocular oncology patients – they roll their sleeves up, put a call out, and help me achieve my goals.
What did you know about ophthalmology in India before you arrived?
In 2010, working for the WHO, I received the Fulbright Presidential Scholarship to come to Pune to help address the issue of preventable blindness. I went to villages hours from the city to screen patients and bring some back for treatment. I was amazed by the dedication of these patients – 90-year-olds walking barefoot in full sun for four hours in the hope that a doctor they didn’t know would cure their blindness. Their faith in us and our abilities shook me to the core. I felt an enormous responsibility for their sight and their lives. That’s why I eventually decided not to come for just six weeks a year. I knew I had to do this day in, day out, because nobody else would.
These days, I have a team of excellent residents in training – they perform quite advanced surgeries from the first year onward – but I am still on call 24/7, because we don’t have enough faculty to cover all the emergencies and more difficult cases.
To me, no experience feels more fulfilling than what I do now. Yesterday, I treated a homeless alcoholic – a 37-year-old man, already blind in one eye, with cornea melting in his other eye. I used an amniotic membrane graft. He said, “All I want is to see your face, doctor.” It broke my heart because, although I was a stranger, in that moment I meant the world to him – and he to me. Such is the ability to return someone’s sight.
What have been your proudest achievements in India so far?
I am very proud of improving the quality of training at my hospital and of starting online lectures and an ophthalmology educational core series available to not only my residents, but ophthalmologists around the world. I managed to get experts from all subspecialties – huge names, such as Carol Shields or Richard Lindstrom – to come together and teach online once a month, with attendees from 41 countries. The US and Europe have excellent conferences and events, but many can’t afford tickets, travel, and accommodation – not just those at the start of their career, but often ophthalmologists with over 20 years of experience. That’s why free, high-quality online teaching programs are so vital. This project has been even more important since the start of the COVID-19 pandemic, so my goal for 2021 is to make it even bigger, with a proper website built to host the sessions and major organizations and eye institutes helping deliver the training.
It is vital that ophthalmologists in developing countries, who might not have hundreds or thousands of dollars to spend on educational conferences and webinars, have access to the highest-quality education. They need to be up to date with current best practice, new developments, telemedicine, and AI solutions.
How have you managed to get such big names to take part in your educational program?
It has mostly been through my network – people I have worked with or met through professional associations, such as the Refractive Surgery Alliance Society, a brilliant group of like-minded refractive surgeons. Sometimes I simply emailed people and explained my goal. Naturally, the first question is, “What is the honorarium?” But as soon as I tell them it is free of charge to all our attendees, they are happy to devote their time with no compensation. I’ve used the snowball effect – once people see how many well-known specialists have participated in these sessions, they are delighted to join.
What goals do you hope to achieve in the near future?
We are trying to get a refractive surgery suite for the Municipal Hospital. It would be amazing if one day we could provide refractive surgery – normally only available to wealthy patients – to this poorest, most underserved population in India. It is a multimillion-dollar endeavor, so it might not seem realistic, but we can achieve it if we just keep putting one foot in front of the other. I’ve started noticing that, when there is a specific, concrete need, people come forward and help.
What are your long-term plans?
I have none. That’s very different from my life 10 years ago, when I had everything planned: medical school, residency, fellowship. The move to India has taught me that I don’t have to plan far in advance. What matters is that I do the best I can for my patients. I’m taking it one step at a time – making arrangements for what is needed right now, and not thinking beyond that.
Do you think you will stay in India?
As ophthalmologists, we are responsible for taking care of our patients’ two eyes but, in certain cultures, people believe we also have a third eye – an insight into ourselves – that we need to discover and open to find the true meaning of our lives.
My deep feeling – perhaps what I can see with my third eye – is that I belong here in India, where folks don’t have a loud voice, but deserve the same care and attention as people in developed countries. I’m staying.