My Story Episode 001 || © Vision Club 2020
Who Rajendra Gyawali is
Rajendra completed his bachelor’s in optometry from IOM in 2010 and master’s degree from South Africa in 2017. He is a Fellow of the American Academy of Optometry and Ezell Fellow (2019). His professional experience includes clinical practice, program coordination, academics and research in Nepal, Maldives, Malawi, Eritrea, Vietnam and Australia. He has research interests in evidence-based practice, refractive error and visual impairment, glaucoma, eye care in marginalized communities and patient centered eye care. He is currently pursuing his PhD at the University of New South Wales (UNSW) as a Scientia PhD Scholar. His current research focuses on improving the delivery of the evidence-based eye care services for people with diabetes. Rajendra is 2019 Ezell Fellow recognized from the American Academy of Optometry Foundation. He is also the founding President of Better Vision Foundation Nepal, a non-government organisation working in improving the access of marginalized communities in Nepal to eye care services, especially the refractive care services.
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How it started?
1 or 2? When I ask my patients which lens, 1 or 2, is better during subjective refraction, I am sometimes taken back in time to remember the hard time I had in choosing between two career paths after my grade 12. It would have been medical lab technology had I checked the box next to bachelor’s in optometry. Few weeks past the entrance exam, my name was on the top of the list for B. Optom at IOM. Looking back to 16 years from where I now stand, the decision I made that June in 2004 turned out to be one of the best decisions I’ve ever made.
From basic optics to community eye care, the course covered very diverse subjects to prepare us for the future. The first year was all about basic courses including optics, community health and basic human sciences such as anatomy and physiology. Second and third year involved all the core courses such as ocular diseases, ophthalmic optics, low vision and contact lenses among others. The final year was about community, research and clinical practice. Although the clinical posting and observation starts from the day one, it was a scaffolding of clinical exposure with additional level of responsibilities in patient care. Learning along with the ophthalmology residents made us adapted to work in a fine interdisciplinary setting. The final year was the most stressful and the most joyful year. We enjoyed a month of community stay and service in Daman of Makwanpur district for our community project. We also had to complete a year-long research project and my project was on quality of life of patients with vision impairment. This was my first research experience and I am grateful that this resulted in my first international scientific publication. We also did a month-long externship at Sagarmatha Choudhary Eye Hospital, Lahan which at that time was the largest eye hospital in the world in terms of number of cataracts performed. These community, clinical, research and external exposures not only prepared us for a career ahead, but also help us see a broader picture of who we will be in future as optometrists.
It was the 8th batch of optometry at IOM and the program was still in its infancy. There were challenges such as limited faculties, lack of optics and dispensing lab, one computer for about 30 people (remember those were the days we did not have laptops and mobile phones like these days) among other. On positive side, the faculties and the seniors loved us and gave their best in teaching the ABC of optometry. Prakash Paudel, Jyoti Khadka, Gauri Shrestha and Asik Pradhan were so impressive as faculties, and were working to the hilt to manage the courses; clinical and research for all 30 students of four batches. I must acknowledge that the most of our learning was through senior ‘dai” and ‘didi’s at our training centre, BPKLCOS. And we felt happy to pass that legacy to a new batch as we became the new seniors.
The college years were mix of every experience one could imagine. Our batch was a diverse group of extremely friendly people from so different background. Rabindra was a thin and lean poet; Man was a man with a great political awareness, Nabin was our musician singer who wore -20D spectacles, Arun was very clever gentleman, Dipesh-the sports person of our group and Nestha was from Maldives for whom everything was a new experience in Nepal. I was the guy who fell for every girl he ever met (kidding!!) and became a poet overnight. In those four years, I managed to go to jail during Loktantrik aandolan and became the president of the student’s society. We had developed a very strong bond over the time and survived several ups and downs. IOM was a very big community in itself and the relationships we built during the time still remains very strong. I was so glad to meet Dipesh last month in Melbourne after so many years.
The journey
Immediately after my fourth year's final exams in late 2009, I worked for an NGO and travelled around central Nepal for a survey of the blind school children. Even before we got our results in March 2010, everyone in our batch had already started official jobs. I joined to a teaching hospital in Biratnagar. I was the only one in the whole department for majority of my 6 months at that hospital. Although I conducted my first independent research (outside IOM) there and attended my first international optometry conference, I was not really satisfied to the job and left it after 6 months' stay.
I moved to the Maldives for a private clinical work in September 2010. I was able to quickly adjust to the local environment and even learnt Dhivehi, the local language. Optometry was new there and Nestha was the first Maldivian optometrist although there were some other optometrists from Nepal (Jeewa dai −2004 batch− and Santhosh dai−1998 batch) and other countries. My three years in Maldives were amazing, personally and professionally. I could feel making real life impact to people’s lives with my work there. I was making so many friends. On the garnish, I had 4 research publications. This was the time I knew I wanted my career to focus on research and academics rather than just clinical optometry.
In early 2013, I left the Maldives, my second home, with heavy heart to join Brien Holden Vision Institute (BHVI) as a lecturer in optometry programs in Africa. Prof Brien Holden was the well-known face of optometry that time and the opportunity to work with such a prestigious organisation was a dream come true although I was a little scared to travel a thousand miles to Africa. I and Suraj (2006 batch IOM) landed in Malawi in late June 2013 and were received by Dinesh dai (2003 batch IOM). After 6 months in Malawi, I was assigned to another program in Eritrea, a small red-sea country located at the horn of Africa.
Eritrea was peaceful with lovely people, but the livelihood was very challenging. Limited water and electricity, lack of basic internet services, ancient banking systems and restriction on groceries were some of the downsides. We had a diploma optometry technician (2+ years) and a bachelor’s degree (5 years) program in optometry. The challenges of an emerging optometry profession and education program was same as elsewhere: limited faculties and resources, professional rivalry and nobody knew what optometry was. Bharat (optometrist from India) and I gave our fullest to create and utilize every opportunity for a better future for optometrists there. Be it curriculum designing or teaching the basic optics or research optometry or supervising in paediatric optometry clinic, I take great pride in what we did there. Seeing those young clueless minds grow as brilliant kind-hearted optometrists was a divine experience of my life. In the meantime, I completed my Masters’ Optometry (by Research) from UKZN, South Africa focusing on childhood blindness in Eritrea. I also received my American Academy of Optometry Fellowship in 2015.
In early 2017, I moved back to Nepal to spend time with my family. The other reason to leave Eritrea was to start looking for opportunities for a PhD, which was not possible with the workload and limited internet in Eritrea. While I was working on my search of a PhD opportunity, I also worked part-time in an eye clinic. But this time period was a much-needed break for me after about 6 years of work. I travelled across Nepal and met many of my school friends. I, along with other optometrists and health professionals, started Better Vision Foundation Nepal, an NGO with a goal of providing eye and vision care services to the most vulnerable population groups in Nepal.
Finding a PhD was not easy. I must have visited the web addresses of hundreds of optometry programs and universities across the world. I made a detailed table of my communications with potential supervisors and program managers. I had my interests and favourites but in desperation I had to widen the search outside optometry. I shamelessly wrote reminder emails to professors, repeated reminders and further reminders if they did not respond. And I waited for their replies. In such desperate times, a good night sleep is a rare event, and I kept on checking the phone every hour even when sleeping. Every email notification with a ‘ting” sound is a hope coming alive, even if the subject line says, “osteoporosis research”. Many of the replies to the emails would direct me to the post-graduate manager or school website, many would put in very sweet words that although I were a good candidate, they could not take you this time for blah blah blah reasons. I had a feeling of sadness and self-doubt, and yet I managed to keep some motivation. Ultimately, there were some positive responses. The discussion moved further, and I got some interviews over skype. Then there were phases of preparing proposals, getting recommendations, long personal statements and filling out long application forms for admissions. At the end I had the scholarship offers from 5 different programs in 4 countries. I decided to go to UNSW, Australia, that offered prestigious Scientia scholarship in the area of my interest.
Before starting my term at UNSW, I joined the BHVI again to coordinate their new optometry program in Hanoi, Vietnam in late 2017. I stayed there for about 6 months mainly focusing on advocacy for optometry and I also taught clinical courses. Coming back from Vietnam, I got married to charming Ms Sushma Lamsal, who also happened to be an alma mater of IOM.
Where am I now?
I am currently a Scientia PhD Scholar (a fancy term of a PhD student), at the School of Optometry and Vision Science, UNSW Sydney. My study is supervised by A/prof Isabelle Jalbert, Prof Fiona Stapleton and Prof Lisa Keay. My research is focused on improving the quality of eyecare service for people with diabetes in Australia. I use both qualitative and quantitative methods and work with Australian optometrists, patients and other stakeholders involved in eyecare services. In Australia, more than 2/3 of the primary eyecare is provided by optometrists and the therapeutically endorsed optometrists manage ocular diseases with prescription medications. There is ongoing discussion for further expanding the scope of practice. We hope that improving the optometric care even by a slightest margin would have a huge public health impact.
Doing PhD is not easy. However, if you are doing something even remotely touching your interest areas, you will love it. I spend about 12 hours in front of my computer when I am not collecting my data, which is interviewing optometrists or visiting clinics. The research direction or methods keep on changing based on several factors. Some days, it feels like you know everything and the next day, there is nothing you know about. It’s like spicy Chatpate, at least for me at this moment. There is always a pressure to achieve more. Fortunately, that is a motivation for me.
What next?
I have no fixed plans yet for my post-PhD life. But I wish to continue teaching optometry, preferably in Nepal. Because there is still so much to learn, the obvious next step would be doing a post-doc in similar environment. Whatever path and place, my career is now all about research and education in optometry and eye care.
Ups and downs
UPS
· Getting into optometry
· Papers
· Patient satisfaction
· Awards and grants
· Travel and people
Downs
· Less time in Nepal and with family
· Living abroad
Tips to Young Optometrists:
I could not come up with any tips, but I learnt some important points through out this journey:
- Optometry (or any profession for that sake) is only very rewarding as long as you put your heart and mind in it.
- There is not a single career path within optometry. Some may like research, other hate it or some take joy in providing patient care and other enjoy teaching. Luckily, these areas are not exclusive, you can be clinician and still continue your passion for research.
- Stick with what your interests are. If you have the quality, there will be opportunity in your interests. I am sure I’d be hating myself had I enrolled in the first PhD opportunity I got, which was in core vision science.
- That said, don’t be afraid to take risks. Its all about calculated risk, look at both sides, gather information, analyse it and talk to people who know better.
- Sometimes you need to take hard decisions and come out of your comfort zones. Leaving the very comfortable job with good income and impact in Eritrea was a very hard decision for me. But if I had not done so, I’d not be here today.
- You need perseverance to be successful. Keep the target in your mind and work on it until you get it. It can be finding a suitable PhD scholarship or starting a new clinic.
- Specific to applying for a postgraduate scholarship (applying to the US school may be a little different though)
a. Build your profile: your academic marks and rankings, the community volunteer services, research experience MATTERS
b. Publications are important – get as many as possible, but don’t forget research ethics
c. Keep in good touch with your referees – try getting a reference letter focused to the course/research area that you are applying
d. Be professional and courteous on your communication to potential supervisors or program managers
e. Do some research about the program or lab or supervisors before applying
f. Avoid very broad and vague one-fits-all type of emails, be specific to the person/program you are writing to.
g. Stop doubting yourself and start applying and keep applying until you get what you need (or something close to it- be practical!)
Thank you for reading my journey in optometry. If you are already in optometry or planning to get into it, I am sure you will love it. The future of optometry is bright in Nepal and around the world. My best wishes to you.
Rajendra Gyawali, FAAO
Scientia PhD Scholar
School of Optometry and Vision Science
3.016 Rupert Myers Building, Barker St
UNSW SYDNEY NSW 2052 AUSTRALIA
T: +61 415744157
And
Founding President
Better Vision Foundation Nepal
Kalanki, Kathmandu
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: Meet Rajendra Gyawali, one of First PhD Scientia Scholar Optometrists from Nepal){kind=link}
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