Dr. Nath Catract Course

BEFORE ARRIVAL
1. After receiving Dr. Nath’s final acceptance to the course, you will need to obtain permission from the Medical Council of India (MCI) for operating in the country. This is a new regulation imposed by the government. To obtain this MCI permission:
A. Download the following file:
https://www.mciindia.org/documents/downloadAppForm/Temporary_Registration_NonSchedule-7A-FTP.pdf Fill the file using your computer, print it, sign at the bottom of each page (signature and date), scan the printed signed pages as a single file, and send the file to Dr. Nath, along with copies of the following documents (computer files):
-Passport main page
-Diploma of your medical degree (Medical School diploma)
-License to practice medicine
-If you have completed your residency: Residency completion certificate (Certificate that you are a licensed ophthalmologist)
-If you are a resident: a letter from the Head of the department sending you for this training. Example text for such a letter:
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Dear Dr Nath,
RE: Sending Dr. _______ for cataract surgery training in your institution.
Dr. ______ is currently a resident in my ophthalmology residency program, in good standing.
Dr. ______ is interested in spending a month in your institute for the purpose of training in cataract surgery. I would be grateful for your accepting him/her to your program.
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2. How to apply for a tourist E-VISA.
Note that all nationals need to get a VISA. No countries are exempted.
The cheapest, easiest and fastest way to obtain a Visa is to do it yourself online, through this India Government website:
https://indianvisaonline.gov.in/evisa/tvoa.html
Please Choose E- Tourist Visa for application
For instructions click the “Instructions for Applicant” button on the left of the page Cost of E-Visa, by country of origin is listed here:
https://indianvisaonline.gov.in/evisa/images/Etourist_fee_final.pdf
For the e-visa application you’ll need to upload a file of a passport-sized photo, and a file of your passport’s main page. Check required file size & dimensions in the above Instructions link
Payment is via Papal or a credit-card (via 2 Indian bank links)
3. Immunizations: provided that your trip is to Agra and back (no visiting of remote parts of India), The Indian government does not require or request that you get any specific immunizations.
It is up to you to ask in you home country and to decide if and what immunizations you might want to consider. Your family doctor can advise and consult you on this topic.
Remember that some immunizations need to be taken weeks before the trip.
4. Reaching Agra: Fly to Delhi International Airport. Agra is a 4-hour drive (180km) which will be best reached via a pre-ordered taxi (see below).
5. Nearby hotels worth considering, that are both conveniently located and of good value include:
A. PL Palace Hotel Agra: for prices and availability check Trip advisor Booking.com, etc.
B. Holiday Inn Agra MG Road: for prices and availability check Trip advisor Booking.com, etc.
Important:
C.Contact Dr. Nath for hotel resevation with discount
-These two hotels are situated close to the clinic and hence recommended. If they are too expensive for you, please consult Dr. Nath before committing to any other hotel/motel.
-The Holiday Inn is the more expensive of the two, and likewise provides a nicer accommodation.
-reserving a room well in advance (at least 6 weeks prior to your arrival) increases your chances of getting a good rate. Waiting for the last minute, you may likely be financially penalized.
-Both are a short walking distance from the clinic (where surgeries take place)
6. Local currency: rupee (approx)
1 USD = 82 INR
1 Euro = 87 INR
1 GBP = 100 INR
1 PLN = 18.7 INR
1 ILS = 23.46INR
7. The drive from Delhi airport to Agra is around 4 hours. A Taxi drive should cost 3,500-4,500 rupee ($US/Euro 55-70). Upon request, Dr. Nath can book for you a Taxi, once you WhatsApp him the flight details. He will send you the telephone number of the taxi driver who will wait for you at the airport.
Driver will be waiting at Exit Gate no.-5 with holding your name plate.
8. In general, Dr. Nath prefers WhatsApp communication, as oppose to emails.
9. Regarding scrubs (operating room clothes): best bring 3 pairs that you are comfortable with.
Scrubs are nonetheless available in the O.R., but will likely not be well fitted and of the correct size you may need.
10. No need to bring surgical hair (head)-caps or surgical masks, they will be provided.

BRING WITH YOU
1. Memory stick to upload videos of your surgeries. If you want all your surgeries on the USBstick (or USB-drive), you’ll need 128GB or so (or several USB-sticks totaling 128GB). Preferably, bring any USB-stick and move the files in parts to your computer, which will need to have roughly 128GB of free space to fit all your surgeries.
2. Bringing a laptop computer is very much advised, to review videos of your cases as you progress, study and read/watch surgery related educational materials
3. Mosquito spray or cream may be advised

IN AGRA
1. It is advised to use a local SIM card in your mobile phone, so that you can call locally to communicate with Dr. Nath, call a Taxi etc.
A local SIM card will be provided by Dr. Nath for the visit and charged with unlimited use for a month (should cost under 500 rupee (around $US 6, or so). This will be your phone/internet cost for your entire 1-month stay!
2. When you arrive at the airport you will not yet have this local SIM (which will be provide to you in the clinic on your first day). Note that you will need to make 1 phone call (or WhatsApp call?) once you land at the Delhi airport to communicate with our Taxi driver once you land.
3. Any communication with Dr. Nath prior to getting the local SIM card can be done via WhatsApp.
4. Tap water and ice-cubes should not be drunk for fear of infection. Food should only be purchased and eaten in respectable restaurants/stores. It is advised not to eat street purchased food. If you purchase fruits, they must be washed thoroughly using bottled water. Makes sure that water bottle is sealed when purchased. Bottled water, 1 liter, costs around 20 rupees.
5. Brush your teeth with bottled water. You can shower with tap water (but don’t drink it)
6. There are a lot of tourist attractions in Agra, besides the world-renown Taj Mahal. All are with a 20-60-minute drive.
7. WiFi exists at Dr. Nath’s clinic (where the surgeries are performed). The password is: Narendra@1986
WiFi should exist in your hotel
However, the local SIM card should provide you with near-unlimited Internet connection so that WiFi may not be needed throughout your stay
8. At the clinic a computer hard-disc server exists, storing your, as well as other’s videotaped surgeries. It contains a wealth of information and materials that can help you study during your stay. Connecting to this server is by _______________
9. A typical day’s routine: Dr Nath sees patients during the morning, you are welcome to observe, but the usual trainee would likely observe for a number of days, and later use this time more efficiently for studying. You are not requested to participate in the clinic and should know that the operated patients come from another clinic. At 13:30 the trainee arrives to the clinic, eats lunch, and towards 14:00 or 15:00 surgeries start. On a typical day you might be assigned approximately 3 cases, and in addition can observe cases performed by another trainee and Dr. Nath.
10. Typically, approximately 2 trainees are trained at any given time. When one started in the beginning of the month, and the other might start in the middle of the month, hence, it is possible that you will spend your month split between a more advanced trainee in the first half of your training, and a younger trainee in the second half of your stay. This is of course often affected and changed by trainees that arrive for shorter (or longer) periods, vacations, meetings and other changes in the schedule. Regardless of the number of parallel trainees, you will receive your cases. In many ways sharing your stay with a colleague has social, training, and educational benefits, of having someone to share your insights, questions and concerns during the training.

GENERAL SURGICAL TIPS
1. Surgical sterility is very different that what you are used to in your home country. Please accept it as a given.
2. The same pair of gloves and gown are worn throughout the surgical day. Gloves are disinfected between cases with alcohol.
3. Patients enter the operating room with their own clothes
4. The microscope used is Zeiss “OPMI Lumera i”
https://www.zeiss.com/meditec/int/product-portfolio/surgical-microscopes/ophthalmicmicroscopes/opmi-lumera-i.html
Download microscope brochure PDF file:
https://www.zeiss.com/meditec/int/product-portfolio/surgical-microscopes/ophthalmicmicroscopes/opmi-lumera-i.html#downloads
5. The phaco machine used is “Sovereign Compact, by AMO”:
https://www.dotmed.com/virtual-tradeshow/category/Ophthalmology/Phacoemulsifier/Models/Amo/Sovereign-Compact/16277
Brochure:
https://www.medwrench.com/documents/equipment/553/abbott-medical-opticssovereign-compact
Forum:
https://www.medwrench.com/equipment/553/abbott-medical-optics-sovereign-compact
6. IOLs implanted are 1-piece hydrophilic acrylic foldable IOL, implanted through a 2.8mm incision
7. The cataracts that you will operate will, in general, be much harder (often brunescent or mature) than you are accustomed to in your country. They are generally more difficult to perform, so that once you become comfortable with them, operating a soft and moderate cataract should be easier.
8. Methylcellulose is the substance used as the viscoelastic material in all cataract surgeries.
9. You will be taught to do the capsulorrhexis using both the cystotome (needle) and the Utrata (forceps) techniques.
10. Nuclear chopping is taught using the “Stop and Chop” technique
11. To allow the unexperienced trainee to learn phaco quickly, during the first half of the course the trainee is instructed not to focus throughout the case, but to leave the focus as it was initially. During the second half of the course the trainee will start using his/her left foot performing fine focusing adjustment movements with the foot pedal.

SPECIFIC SURGICAL TIPS
1. Enter the eye with the phaco needle in a “bevel up” orientation
2. Cystotome (needle) capsulorhexis can be performed through a small (1.1mm and less) opening, while Utrata forceps rhexis can only be performed through the main (2.8mm) incision
3. Continuous irrigation can be turned on/off from the pedal (quick push on the left button) or by asking the scrub nurse
4. The right foot pedal ontrols the phaco machine. The left foot pedal controls the microscope focus and zoom.

Hotel THE PL PALACE (Walking distance of 350m takes 5 min to reach center)
In front of Income Tax Office,
Mahatma Gandhi Rd,
Sanjay Palace, Civil Lines,
Agra, Uttar Pradesh 282002
Phone:+91-0562 255 8800

HOLIDAY INN HOTEL (Walking distance of 450m takes 6 min to reach center)
Commercial Complex,
16/2/8,Mahatma Gandhi Rd,
Sanjay Palace, Civil Lines,
Agra, Uttar Pradesh 282002
Phone:+91- 0562 423 3333