India Alliance Fellow Spotlight: Srinivas Marmamula, LVPEI, Hyderabad
01 Apr 2019
Dr Srinivas Marmamula, Early Career Fellow, L V Prasad Eye Institute, Hyderabad, India
Can you tell us about your journey so far?
Since my early childhood days, I always wanted to become a doctor and work for the community. But hailing from a lower-middle-class family in Hyderabad, the challenges were many. Even completing my basic graduation was beyond our means. After finishing my 12th standard, I enrolled myself in the ‘Diploma in Ophthalmic Techniques’ offered by L V Prasad Eye Institute (LVPEI). Though initially reluctant, I completed the course and continued to remind myself that it was just a stop-gap arrangement and soon I would get back to my dream profession. I completed my graduation and post-graduation while still working at LVPEI. After two failed attempts to get into medicine and civil services, I finally decided to continue at LVPEI and keep looking at new avenues to work in the community.
Playing an important role in the Andhra Pradesh Eye Disease Study (APEDS) project, the landmark study that brought laurels to the institute, and then developing the Vision Technicians’ course and helping in the realisation of Dr Gullapalli N Rao’s vision of Vision Centres as a part of larger pyramidal model of eye care service delivery are my major achievements that I am proud of. The results, I am a full-time faculty member and Associate Director of the vibrant and ever-expanding public eye health team that impacts over a million every year!
Did you always want to focus on public health?
While I was posted as a fellow at one of the LVPEI’s partner hospitals in the West Godavari district in Andhra Pradesh, I got a chance to meet Dr Lalit Dandona. Within just a few minutes of my discussion with him, he asked me to work with him for the Andhra Pradesh Eye Disease Study (APEDS), a large scale epidemiological study, which not only has been a turning point for the eye care sector in India, but also for my professional career. This four-year-long study (1996-2000) carried out by LVPEI resulted in numerous landmark publications in the field of Community Eye Health (or Public Eye Health as some people prefer to call it). Working under the great leadership of Dr Dandona, I got the opportunity to co-author the manuscripts from the study. A researcher to the core, he has had a profound influence on my career.
The London School of Hygiene and Tropical Medicine was the next major turning point in my career, where I did my Masters in Community Eye Health at the International Centre for Eye Health. Learning from stalwart faculty such Dr Allen Foster and Dr Clare Gilbert, redefined my outlook towards research. Working with Dr David Friedman as a post-doctoral fellow at the Dana Center for Preventive Ophthalmology at Wilmer and taking courses at the Johns Hopkins Bloomberg School of Public Health, provided me with the perfect platform to establish myself as a researcher in the field of public eye health. Additionally, the mentorship support that I have always received from Dr Jill Keeffe during my doctoral studies has profoundly influenced the way I conduct my research.
Public Eye Health as a specialization is relatively new in India, especially for those from optometry/eye health background. I have chosen to take ‘the road less travelled’. The inspiration for this came from Dr Gullapalli N Rao with whom I have the privilege of working very closely. His passion to make quality eye care accessible to even the most neglected population and his visionary leadership inspires me even today. He continues to throw new challenges at us, at the same time keeps us motivated and provides us with ample opportunities to excel.
What are you currently working on?
My current research subject is of great interest to me. I aim to study the prevalence, causes and impact of vision loss in elderly people living in residential care centres in India. The focus is also on understanding the relationship between vision loss, hearing, depression and incidence of falls in the elderly. Preliminary analysis reveals that one out of every four elderly in the studied population has vision loss; a large proportion of this vision loss is avoidable. Preliminary analysis also reveals a direct association between vision loss and fear of falling and depression. We are now in the post-intervention phase, wherein I am trying to understand the impact of our intervention (spectacles and cataract surgeries) on their visual functions, falls, and depression.
What is the impact of your work?
My initial research was focused on developing novel rapid assessment methods in public eye health. I developed two rapid assessments methods (Rapid Assessment of Refractive Errors and Rapid Assessment of Visual Impairment) as a part of my PhD and in the later years. These methods are now being used by several researchers around the world. I am a strong believer in the fact that there should not be any survey/study without service. All my research projects have strong built-in component of service provision.
As mentioned earlier, I was instrumental in developing the vision technician course at LVPEI that started two decades ago. It is highly satisfying and equally rewarding to witness this vibrant team of vision technicians being at the vanguard for addressing vision loss at the community level through primary eye care centres.
Moving forward, I aim to develop a similar course (and probably call it the GT—Geriatric Technicians) to train health workers to provide comprehensive eye care to the elderly in community eye health care setting. This workforce will be trained to provide a primary level of care and asses them for systemic health issues including eye health and other similar challenges. This is envisaged to act as a triage to facilitate appropriate ‘need’ based services and follow-up. This initiative aligns perfectly with my belief: ‘Healthy Aging = Happy Aging”. Now is the right time to work on it.
My research in the last few years has given me constructive insights about eye health issues faced by specific groups of people. I would like to work on larger need-based initiatives, which I would like to call ‘vision for the vulnerable initiative’. This will also encompass people engaged in traditional and allied livelihoods.
What is your favourite part of working in the field of community health care?
Working in rural communities is very gratifying. Being an ‘agent of social change’ through eye care is something I will always cherish. My work also quenches my thirst for travelling—especially experiencing rural India and its flavours, culture and cuisine. What also highly appeals to me is that I get to admire the beauty of nature: the lush green fields, people at work, and the beautiful terrains. Being an ardent photographer, whenever possible, I try to capture these experiences through the lenses of my camera to show it to the world!
Also, as most of my education has been funded through scholarships (public funds), I consider it my duty to contribute to science and society. My work alleviates the problems of the underprivileged in India; this is the most rewarding aspect of my career and is a token of my gratitude.
What is your biggest challenge or struggle in this field?
At times, things do get a little difficult; especially, when people from the community show resistance towards the uptake of eye care services. What becomes challenging is convincing them that getting their eyes examined is for their own good. Long travelling hours in difficult terrains, clubbed with not very comfortable transport options does pose a challenge. Also, for a vegetarian like me, food also is an issue at times; however, over the years I have learnt to manage most situations. Getting good people to work in rural communities is also another important challenge, which we face often in community research.
How has the Fellowship from India Alliance helped you?
The India Alliance fellowship is one of the greatest things that have happened to me. It provided me with the opportunity to pursue research in my area of interest. Apart from adding to my credibility, the flexibility that this fellowship offers has been phenomenal. The India Alliance package has a very comprehensive structure and allows you to upgrade your skills by providing funding for overseas training and workshops. The hallmark of the fellowship is the protected time for research that you get.
The Wellcome Trust/DBT India Alliance fellowship has been an excellent platform for me to realize my aspirations to become a better researcher in public health.
What changes do you envision in the research ecosystem in India to support early career clinical and public health researchers?
Full-time research is not seen as a career option by many clinicians. I think the impact of the India Alliance fellowship is being felt now as more researchers are willing to apply for it. I believe there will be a significant increase in the number of researchers in all areas and unrealised research potential in India will be unveiled in the coming years.
What role do you think scientists can play in society today?
Many times, the work of the scientists is confined to the four walls of their labs and often only translates into peer-reviewed publications. There is a definite need to bridge the gap that currently exists between the researchers/scientists and the society at large. We as scientists and researchers need actively engage with society and brainstorm together to address the many challenges that currently prevail.
The endpoint should be a ‘positive change’, either in our understanding of a phenomenon or newer solutions to these challenges. Thanks to the efforts of India Alliance, the Indian researchers and scientists are now embracing this way of working.
In the public health sector, the involvement of the researchers can bring about impactful policy changes. Recently, I was on board as a technical member for a universal eye health program initiated by the State Government of Telangana—probably it is the largest eye health initiative ever undertaken. These kinds of collaborations are the way to establish meaningful sustainable community eye health initiatives.
Your photographs are very expressive both visually and contextually. Could you talk about this interest of yours?
Photography is my passion. Though not formally trained, I have been doing photography for several years now. Fortunately, my work provides me with many opportunities to live my passion.
I want my photography to portray my research and the rural communities that I believe are the ‘True India’. Photography is like soul time and a stress buster for me. My camera becomes my companion and oblivious to the issues around, we spend hours capturing and making memories. This keeps me in the right spirits to handle all the challenges that come my way.
If not a scientist, you would be a...
That’s a difficult question. Teaching is my passion and probably I would have become a full-time teacher. Since childhood, I wanted to work in rural areas, tried civil services but couldn’t get through. Even if not a scientist, I would still be working in the rural development sector, that it for sure.
Finally, what’s your support system?
My family! My wife Madhavi and my son Harshavardhan support all my endeavours so that I get to live the life of my choice, travelling extensively as part of my research on a very frequent basis.
Photos by © Dr Srinivas Marmamula