Dr. P Namperumalsamy: Father Figure, Son of the Soil, Stalwart Surgeon – Immortal Icon

"We make a living by what we get, but we make a life by what we give." - Winston Churchill Greatness is never forged in the cradle of comfort; it is birthed in the cauldron of hardship. And so, it was with Dr. Namperumalsamy. His incandescent persona, extreme diligence, and inspiring leadership kindled the flame of retinal surgery, science, as well as service in this nation, and for half a century, he nurtured and watched it light up the lives of multitudes. Once upon a time in the South: Dr. Nam (as he was fondly called by his many friends and well-wishers) was born into an agrarian family in a small, sylvan village tucked away in a remote corner of the Theni district of Tamil Nadu. Education there, in those times, was something few aspired for and even fewer achieved. Of very modest means yet fuelled by the dreams of hard-working parents, he persevered on – walking miles, wading through rivers, through loans, fee concessions, and scholarships, he completed his schooling meritoriously and won admission to the prestigious Madurai Medical College in 1958. Diligent and studious, he impressed his teachers, especially Dr. G Venkataswamy, who was to play an enormous role in his life later. Graduating in 1963, it was Dr. V (as the Chief was affectionately called) who motivated him to take up ophthalmology.1 In 1965, Dr. Nam married Dr. Natchiar, Dr. V's younger sister, and together forged one of the greatest partnerships in eye care. Sapling to Stalwart: Soon after he completed his postgraduation in 1966, Dr. Nam joined the Eye Department at the Government Erskine Hospital, Madurai and began the Low Vision Service there a year later. The posterior segment in those early days was largely a mystery. Dr. Nam, demonstrating a trait that was to define him for decades, chose to take up the challenge and almost single-handedly practiced indirect ophthalmoscopy as well as managed retinal diseases. Under Dr. Venkataswamy's prescient leadership, several international luminaries crossed the portals of the department. Dr. Morton F. Goldberg, Director of the Ophthalmology Department, Illinois University, struck by his passion for the posterior segment, offered Dr. Nam a two-year medical retina fellowship as part of the famed Diabetic Retinopathy Study in 1972, under his and Dr. Gholam Peyman's tutelage.1 Invigorated, Dr. Nam returned to pursue retina with greater fervour. In 1976, Dr. Charles L Schepens, inventor of the binocular indirect ophthalmoscope and a doyen of retinal surgery, while in Madurai, offered Dr. Nam a surgical retina fellowship at Boston. Prevalent regulations required Dr. Nam taking the hard decision of resigning from government service to pursue this opportunity. On return, the first Vitreous Surgery Center in India was established in 1975 at the Government Rajaji Hospital, Madurai, wherein the first vitrectomy in our country was performed. The Retina-Vitreous Clinic, with Dr. Nam at the helm, was soon founded at Aravind Eye Hospital in 1979, and the Vitreo-Retina fellowship was initiated a year later.1 It was to rapidly become one of the largest in the nation, spawning legions of retina surgeons, many of whom are leading Retina Services all over the country with distinction. Dr. Nam was, as time was to show the world, a truly unique individual who had many callings, and he fulfilled each one of them with glorious distinction. First Calling – Championing Retina, Diabetic Retinopathy, and Speciality Services in Aravind Eye Care System (AECS): Over the next few decades, the Retina department, under Dr. Nam, established itself as a national center of excellence in retinal disease management, Speciality Diabetic Retinopathy (DR) and Surgical retina. Recognizing the enormous morbidity of DR in the country, Dr. Nam, a self-declared "crusader" against DR, picked up the gauntlet with fierce resolve, launching the Aravind Diabetic Retinopathy Project in 2000, to provide wholesome care to all facets of the disease. His astute organizational acumen came to the fore, as he engaged with government as well as international institutions like Technology, Information Forecasting and Assessment Council (TIFAC), World Diabetes Foundation (WDF), Lions Club International Foundation (LCIF), and several other public–private entities.1,2 Diabetic retinopathy screening programs – physical, mobile van and software driven, instrumentation development like retinal lasers and ophthalmoscopes – certificate courses in DR, laser training, fundus fluorescein angiography, ultrasonography gained impetus.3 The Aravind DR grading software has been recognized as one of the original efforts at automation in detecting DR and formed the seed technology for future artificial intelligence screening programs.4 Dr. Nam was equally passionate about promoting novel diagnostics and therapies in other specialties like glaucoma, ocular oncology, uveitis, age-related macular degeneration, and retinopathy of prematurity. He constantly encouraged respective heads of services to enhance departmental capabilities to achieve the highest levels of patient care on par with global standards. He placed a premium on evidence-based management as well as ethical care. It was largely due to his untiring efforts that AECS, around the turn of the millennium, transitioned from primarily a cataract blindness eradication center of repute, to a multi-speciality endowed institution renowned for excellence in every branch of eye care. Education is Empowerment: Dr. Nam, despite his demanding clinical and administrative duties, always found time to take classes for residents, which were intimidating but replete with vital clinical pearls. We, as residents, realized how invaluable these were when on the cusp of exams. He conducted Grand Rounds, Journal Clubs, and Morbidity Meetings, with an iron hand but also with charisma and grace. Deploying teleconferencing technology in the 90s, (way ahead of the current era of webinars), he spearheaded AECS's presence in virtual meets with premier institutions like Johns Hopkins, Joslin Diabetes Center and Massachusetts Eye and Ear Infirmary of Harvard. The case presentations, didactic classes, and fluorescein rounds during the retina fellowship program, with Dr. Nam at the helm, were well known for their searing academic intensity and erudition. Lessons learnt there, as fellows, would always remain ingrained in our memories. He was also particular that optimal training was imparted, and best practices were followed by the paramedical staff, too. Peer Recognition – First Among Equals: For his outstanding individual contributions and as a leader of one of the world's premier eye care organizations, Dr. Nam received a slew of awards – the Padma Shri in 2007, the BC Roy Award in 2006, and the Achievement Award by the American Academy of Ophthalmology in 2006, and in 2010 was recognised by the TIME magazine as one of the most influential leaders. A part of the revered Retina "trinity" of India, along with Dr. SS Badrinath and Dr PN Nagpal, Dr. Nam has been acknowledged as India's first vitreoretinal surgeon. Second Calling: Beyond Institutional Boundaries Dr. Nam, while focused on creating world-class infrastructure within the tertiary hospital at Madurai, never lost sight of the fact that the real need was to serve the masses in the countryside. While the traditional community outreach camps were the standard and considered effective, studies at Aravind soon showed that only 7% of the population in need of eye care actually accessed these camps. Resilient and resolute, Dr. Nam refused to bow down to the enormity of the problem. The challenge was surmounted ingeniously, leveraging technology and through the creation of a network of primary vision centers (VC) across the State.5,6 Seed funding for these VCs came from a large grant from acumen, a non-profit organization, in 2002. Inspired by Dr. APJ Abdul Kalam Azad and collaborating with international technology leaders like the Intel Research Lab at Berkeley, California, high-bandwidth wireless tele-connectivity was employed to link these VCs, run by trained vision technicians, to base hospitals, where teleconsultations with ophthalmologists offered eye care to almost 90% of the populace in need. Today, 118 VCs serve and provide eye care to vast areas of rural and remote Tamil Nadu. Third Calling – Reaching out with Research: With one surgery, you treat one individual, but with one idea, you can offer succour to millions. In his last avatar, Dr. Nam embodied this truth. All through his career, he had established collaborations with multiple reputed international centers, publishing seminal papers and actively promoting an environment conducive to impactful research and publications. Over the last couple of decades, in an amazing final display of energy, he threw himself headlong into galvanizing Aravind further toward research. Largely instrumental in developing the Dr. G Venkataswamy Eye Research Institute, he helped develop an ecosystem and a genre of basic scientists and clinician-scientists, the offshoot being a significant quantum of meaningful translational research publications. Family man to the fore; Children at his core: Despite his taxing schedule, Dr Nam displayed another rare trait that few have mastered – work-life balance. He never allowed his busy professional life to overshadow his personal life. He played the role of the loving patriarch, bonding and binding the family together. Up until his last days, four generations of family stayed in the same house. He would attend all family events, not only within the extended family but also those of relatives in the village. Dropping the grandchildren at the bus stop remained a pleasant daily duty of his. More recently, the treasure of his personal life was the presence of his one-year-old great-granddaughter with whom he would blissfully spend a couple of hours every day. Success is what happens to us. Significance is what happens through us. - Mark Cole Dr. Nam remained to the end, a father figure to many, a son of the soil and one who never ever forgot his roots. An incredible human being, a gentle giant, whose footprints in the sands of time and science will stay for posterity, reminding us of our sacred duty to stay true to our chosen path. We thank you, sir, for being the mighty bow that strenuously bent for decades, releasing each one of us and helping us find our marks in our communities. Farewell sir, as you rest in eternal peace enshrined in the pantheon of the immortals, may you find us worthy of the inspirational legacy you left us with.