The world is bright, save your sight: World Glaucoma Week
Creating awareness, educating the public on glaucoma; sensitising physicians and training general ophthalmologist and optometrist to screen for glaucoma are some vital steps to detect glaucoma in time and prevent vision loss.
To mark the World Glaucoma Week, VISION 2020 INDIA spoke to Dr Surinder Pandav, President, Glaucoma Society of India, a member of VISION 2020 INDIA, about the challenges faced in India in managing glaucoma and what steps can be taken to prevent blindness arising from glaucoma.
Dr Surinder Pandav is a glaucoma specialist at Advanced Eye Center, Postgraduate Institute of Medical Education and Research, Chandigarh.
V2020: Dr Pandav, what is your message for the glaucoma week.
Dr Pandav: The theme for this year is very apt. The world is bright, save your sight! Eyesight is very precious and it should be our duty to protect it. Glaucoma is the sneak thief of sight, so be aware of that thief. Most importantly, be aware that vision loss is irreversible due to it, but also be aware that it is preventable, if we take appropriate action in time. If you are 40 years plus, go get yourself examined for glaucoma.
V2020: In India, glaucoma is the fourth largest cause of preventable blindness and we also have a growing greying population. What can we do to prevent blindness from glaucoma.
Dr Pandav: The biggest challenge is lack of awareness and sensitising the general ophthalmologists and physicians about glaucoma.
Educating the public is very important. Glaucoma does not have any obvious symptoms. By the time patients come to know they have glaucoma, considerable percentage of their sight is lost, which is irreversible. But if one is equipped with even a basic awareness about the eye disease one can ask an ophthalmologist for glaucoma screening during a regular eye check up, especially at the age of 40 -45. If detected early, the vision loss can be stopped or will be minimal. It can make a lot of difference to the outcome. Three categories are at high risk in the population:
- Family history
- Age related
V 2020: Now days, to get a pair of reading glasses, an optical shop is preferred. Can that be a point for glaucoma screening? Is the man power in such shops equipped to do the screening?
Dr Pandav: Many a times, optical shops are the first contact for getting glasses prescribed. In India, many in an optical shop may not be trained for glaucoma screening. But optometrists can be trained to screen for glaucoma. A basic screening for detection would require eye pressure checking and examine the optic nerve. Eye pressure check with automated equipment is easy. But it is the examination of optic nerve that requires a trained person. The alternative could be to take a picture and send it to an ophthalmologist. Else in case of an increased eye pressure, patient can be referred to a trained ophthalmologist. This way we can cover a large population.
V2020: For a large part of rural India, health care is still not accessible. How can one reach the unreached in the community for glaucoma detection?
Dr Pandav: In India, close to 90% who have glaucoma is un – diagnosed. So we are actually treating a small number of people. If you look at the risk factors, there will be close to 12 million people in India with glaucoma. To get this population to the doctor is the challenge. As ophthalmologists and medical care is still inadequate in rural areas, the percentage with a vision loss is higher there.
For glaucoma diagnosis, the only sure way is for the patient to reach a qualified ophthalmologist. A proper diagnosis involves multiple steps. If physicians, general ophthalmologist and optometrist can be trained to detect glaucoma, we can reach out to a larger population. If an ophthalmologist is examining an elderly patient, they need to be sensitised to look out for glaucoma. Public education also has a role to play. Spreading knowledge through NGOs working with the community will boost awareness.
V2020: Along with vision loss for the patient, there are several socio – economic factors that need to be considered. That is an integral part of the disease management but largely not addressed.
Dr Pandav: One cannot emphasise enough the reason for detecting the disease early. When a patient realises about loss of vision and that it is irreversible, there is a huge sense of fear, anxiety about the future, old age, family, finances and some do get into a depression. Glaucoma is a chronic problem, the treatment lasts for several years; it is lifelong. There is also a burden of care. On the economic front, it is a recurring expense, with regular visit to the doctor, medications and annual checkups. And if the vision deteriorates, there is a need for family and social support as well. The problem gets compounded as the vision deteriorates. It is a stress not only for the individual but also the care giver, the family members.
Patients being treated for glaucoma do not see any obvious improvement in their vision. It can be de motivating and act as a deterrent for continuing treatment. In fact there could be some side effects of the treatment. Hence counselling is very important. An understanding between the doctor and patient is very important and here there is a large scope for counselling, this is missing. We need to develop that cadre.
V2020: Are there any support groups for patients in India.
Dr Pandav: PGI, Chandigarh has a glaucoma support group started about 12 years back. We conduct awareness programme twice a year in March and November through public lectures, street plays, musical concerts etc. with messages on glaucoma, screening etc.
We also conduct education programmes for general ophthalmologists to sensitise them about glaucoma. A challenge we faced is the economics of providing glaucoma related services. Cataract and refractive error correction is more paying whereas managing glaucoma is not so lucrative. But we do try and incite some interest in these doctors to screen for glaucoma as well. There is a need for referrals from them to glaucoma specialists.
There are few dedicated glaucoma hospitals or clinic. Since cataract is still the leading cause of visual impairment most private practitioner will focus on cataract surgery. As it is very gratifying to patients as well as doctors. So we have to look at imparting training for glaucoma diagnosis and management to such ophthalmologists.
V2020: What is the role GSI.
The Glaucoma Society of India is a group of Indian eye specialists and scientists who are purely glaucoma centric or have a special interest in glaucoma. It aims at disseminating current practice patterns and help ophthalmologists in different parts of India to upgrade their skills to promote excellence in patient care and help preserve their vision related quality of life.
VISION 2020 INDIA advocacy brings ‘Choker Alo’ in West Bengal
An advocacy initiative by VISION 2020 INDIA for Universal Eye Health in West Bengal saw the light of the day as the Chief Minister, Ms Mamata Banerjee launched ‘Choker Alo’ Eye Health for All scheme in West Bengal on 4 January 2021 virtually. “Our aim is eye health for all by 2025 in the state,” announced the Chief Minister, Ms Mamata Banerjee.
The first of its kind eye health scheme in the state, the West Bengal Universal Eye Health project aims for free cataract surgery for senior citizens, eye health screening and treatment from the new born to senior citizens in the next five years.
The seed of this advocacy move was initiated by VISION 2020 INDIA board members from West Bengal, Dr Rajesh Saini, National Coordinator and Dr Asim Sil, East zone representative and Sightsavers who conceptualised the proposal and submitted a concept to the health ministry, initially in August 2020 and the final one in December 2020. A proactive bureaucracy and optimistic VISION 2020 INDIA board members ensured concept to project.
“It is a big initiative in the state”, felt Dr Asim Sil, East zone representative while Dr Rajesh Saini, National Coordinator on the VISION 2020 INDIA board was glad “the state government’s initiative is all set to improve the eye health system in the state.”
In its first phase being rolled out from 5 January 2021, 20 lakh senior citizens will be operated for cataract. “Wherever required, they will be provided with free spectacles”, promised Ms Mamata Banerjee during the launch of the scheme. In addition 4 lakh students will get free spectacles. In its 1st phase, 1200 gram panchayat and 120 primary health centres in the cities will be catered to. Three hundred eye surgeons and 400 optometrists and 63 NGOs working in West Bengal will be involved in this work according to the Chief Minister.
The goal of the Universal Eye Health Programme submitted by board members of VISION 2020 INDIA to the government proposed to strengthen the efforts in preventing avoidable blindness, provide universal and equitable service, and ensure effective implementation of the program. “We are glad that most of our proposals have been incorporated in the programme outlined by the Directorate of Health Services, West Bengal,” said Dr Rajesh Saini.
The concept note outlined an urgent need for Universal Eye Health Programme as the present eye care activities were largely cataract and refractive error centric and neglecting major non cataract blinding conditions that needed urgent attention. Not enough was being done for prevention of blindness from diabetes rapidly increasing in prevalence. Blindness prevention cannot be a vertical activity and should be horizontally integrated with other programmes to be more effective. Resource should be mobilized to underserved districts to ensure equity.
The West Bengal Universal Eye Health project under the Directorate of Health Services, West Bengal will ensure the maximum utilisation of available public sector resources India healthcare in a more systematic and more accountable Manus to ensure services with a smile on the caregivers as well as on the beneficiaries this will make the public Healthcare system more efficient more productive more from and more accountable.
State will make a focused effort for the need based trending of the eye care services uniformly in the state on one hand the expertise in a public sector will be utilised maximally and on the other the state will explore the modalities to enrich the system with the ideas from the experts from other sectors the overall goal of this project is to ensure quality I care services with further enhancement in the service spectrum uniformly to each and every resident of the state at any age of the life cycle.
The remarkable hundred years journey of RNC Free Eye Hospital
RNC Free Eye Hospital, Valsad, Gujarat is completing 100 years of its establishment in June 2020. On 1st June, the hospital launched its centennial year celebrations with a small scale program. A bouquet of praises and wishes to RNC for sustaining their eye care services to the pre – dominantly tribal population in south Gujarat and adjoining state of Maharashtra.
From 1920 to 2020, it has been a remarkable hundred year’s journey for RNC. It has witnessed several changes in the field of eye care. From the torch light ophthalmology to the present equipment dominated one, the hospital has kept pace with the changes in ophthalmology boasting today of the state –of- the- art- technology in eye care.
The current 81 bedded eye hospital’s origin was a humble four bedded stand alone eye hospital in a rented accommodation. The year 1920 was when work in blindness was gearing up in India. In 1919 the Blind Relief Association was formed by leading citizens of Bombay (now Mumbai) with a view to prevent blindness with opening of centres in Chalisgaon in Maharashtra, Surat and Valsad in Gujarat.
The original hospital building in 1920
The experiment of Blind Relief Association was successful and led to the establishment of RNC – Ratanji Naththubhai Chavsarewala Free Eye Hospital with the objective to prevent blindness by providing eye care facility in south Gujarat free of any charges to the patients.
Established by Shri Khanbahadur Sheth Dadabhai Ratanji Balsara (Chavsarewala), who provided the seed money for this noble work, there is one aspect that has remained constant with RNC through the years. It is their founding objective to provide free eye care service to patients regardless of their economic status. “We do not charge any fees from the patients. They may belong to the economically weaker section or may have the capacity to pay, but once they come to us for treatment, we consider them equal” says Mr Bharat Desai, Chairman Trustee, RNC Free Eye Hospital. Cross subsidy approach is something they do not consider.
In the founding year, cataract and refractive error were started. In the hospital’s first annual report – yellowed pages available in the hospital’s archives – states that 1-7-1920 to 31-12-1922, 133 extraction of lens was performed. In addition of number of other services were also rendered.
Filling the huge need as it was of eye care in the pre dominant tribal area, patient volume kept increasing. It was too large to be accaccommodated in the hospital’s rented accommodation. Dr Paragji Desai was the lone ophthalmologist who manned the clinic with a handsome remuneration of rupees 250/ a month. In fact the name of the road where the hospital is located is now named in his honour.
Gradually as word about the facility spread and demand for larger hospital grew, donors came forward and more rooms were added. Block by block was built with funds matching needs through donations. More beds were added gradually growing to its current
capacity of 81 beds. From among celebrity donor was famous cine star, Ms Nirupa Roy, belonging to Bulsar, whose generous donation built an OT which was inaugurated by well known personality, former Prime Minister of India, Shri Morarji Desai in 1958.He was also a native of the place.
Today the total surface area of the hospital is approximately 4212 sqmt with state – of -the -art buildings housing OT, OPD, Retina Unit with 5 OT and 1 Septic OT. There are 15 cubicles for examination by doctors for refraction and housing various instruments.
From the basic eye care services to a comprehensive eye care services offering 11 specialties, from one OT to six OT’s, the RNC Free Eye hospital kept growing and improving their facilities. Today RNC performs an average of 13,000-17,000 operations a year and 1Lac to 1.2 Lacoutpatients’ volume in a year.
Mr Bharat Desai is proud of the hospital’s infection free record with a success rate of 97%. “Cluster infection has never been observed since hospital’s inception”, says Mr Bharat Deasi.
“A big celebration was planned for 30th June but due to COVID-19 related situations it is postponed to 16 August, Parsi new year or later,” says Dr. Rohan Chariwala, Associate Medical Director, R.N.C Free Eye Hospital. Planning for the future, the hospital aims to stick to their founding objective: provide eye care with quality and free to all. We wish them luck in their future journey.
Corona Warrior: Call for duty or love for her child
When thirty – year old Mrs Mudrika Munde, nurse from D. S. Karad Eye Institute, Latur, Maharashtra, volunteered to nurse a corona positive patient, it was the call of duty that prevailed over the love of a mother.
For a period of 20 days, Mrs Mudrika left the care of her six year old to her husband. It was heart wrenching for the mother in Mrs Mudrika to not even afford a glimpse of her child. This was not her normal duty pattern when she would return home after her duty hours to hug her son. She knew she would be completely isolated for more than two weeks.
Mrs Mudrika shared that she would push her motherly feelings aside to concentrate on her professional work.
During her hospital bound duty, Mrs Mudrik’s husband brought their son twice to the hospital to meet. But adhering to the strict protocol and not to risk her family with the infection, Mrs Mudrika could noo meet or see her family even from a distance.
The care and treatment resulted in the patient being cured and tested negative after 19 days.
A satisfied Mrs Mudrika was ready to return home and a grand welcome awaited her. Residents of her apartment welcomed the corona warrior with loud clapping and showing of flower petals. The corona warrior could not stem her tears.
Presidential Address by Dr Taraprasad Das, President, VISION 2020 INDIA at the organisation’s 15th annual conference inaugural.
The 15th annual conference of VISION 2020 INDIA ‘ Achieving Universal Eye Health for Everyone & Everywhere‘ was hosted by Aravind Eye Hospital, Chennai on 8 & 9 June 2019. Governor of Tamil Nadu, His Excellency Shri Banwarilal Purohit inaugurated the conference. Dr Taraprasad Das, President VISION 2020 INDIA addressed the 600 conference delegates.
Sophie, a young Ophthalmic Nursing Assistant from Changlang district, Arunachal Pradesh participated in one of the VISION 2020 India hands-on workshops. She spent additional month training at the host institute. Returning to her district, she was confident enough to help increase annual cataract surgery from 40 to 500 with minimal complications. The Government of India declared this 11- village cluster in Arunachal Pradesh free of cataract blindness in 2017. Isn’t this very powerful?
Kajol, a young Ophthalmic Technician from Mastichak, Bihar polished her patient interaction skills including the nuances of refraction in another VISION 2020 India hands-on workshop. Because of her enhanced ability, the ophthalmologist in the eye centre could spend additional quality time in treating people. Do you see a value in it?
These are the success stories of VISION 2020 India workshops. There are many similar ones spread over the less reached India.
Shri Purohit, the honorable Governor of Tamil Nadu, Professor Namperumalswamy, honorable Chairman emeritus, Professor Ravindran, honorable Chairman, and Dr Haripriya Aravind, the Organizing Secretary, all from the Aravind Eye Care System, my fellow Executives, honorable Members, and Friends of VISION 2020 India.
Greetings to all of you.
Global VISION 2020 is a 2-decade old organization and the VISION 2020 India-a 182- member strong eye care advocacy organization- is a decade and half old. We are the public health arm of ophthalmology- the bridge between the science and the society, a bridge between the Government and non-Government eye care providers
Health transitions dictate our health policies. The health transition evolves in response to demographic, socio-economic, technological, political, cultural, and biological changes. Two important health transitions are: (1) Demographic and (2) Epidemiological. The demographic health transition depicts the changes from high fertility- high mortality, a reality in less developed countries to the low fertility- low mortality, a fact in more developed countries. The epidemiologic health transition depicts the changes from infectious to chronic diseases. Three major mechanisms in health transition are – the decline in fertility, the changes in disease risk factors, and the improvement in health care technology. A decline in fertility impacts the distribution of people in the society. The changes in risk factors impact the incidence and pattern of diseases. Improvement in health care technology impacts the fatality rates.
India stands in the middle of this transition. We, and many countries of similar economy are engaged in a dual fight of containing a developing country’s disease pattern and delaying a developed country’s health disorders. Having said that, the eye care in general has performed reasonably well globally. The Vision Loss Expert Group reported a decline in global blindness from 0.75% in 1990 to 0.48% in 2015, and a decline in global the visual impairment from 3.8% in 1990 to 2.9% in 2015. But this did not translate into reduction of absolute numbers of affected people. In fact, the number of blind people in the world has increased from 30.6 million in 1990 to 36 million in 2015; the number of visually impaired people has increased from 160 million in 1990 to 216 million in 2015. While we attribute this phenomenon to population rise and aging, we must also admit that our efforts have not matched the demand. What is worse, with the current trend, it could increase to 237 million visually impaired and 38.5 million blind people by year 2020. This is ironical because by year 2020 we were expected to be 20/20 good.
So what should we do?
Actually this was kind of anticipated a decade before VISION 2020 was formed. Attended by 137 countries and 67 international organizations the WHO convened meeting at Alma- Ata 1978 was a major advance in this direction. The Alma-Ata declaration identified primary health care, PHC, as the key to attainment of the goal, Health for All. This is the meeting where the health was defined as a state of complete physical, mental and social wellbeing and not mere absence of disease. Forty years later, in 2018, the WHO reconvened the meeting to reemphasize the benefit of Primary Health Care. The PHC has all 3 main elements of good health care: (1) integrated services, (2) multi-sectorial policymaking, and (3) empowering people and communities.
PHC in eye care begins at the Vision Centers, at the bottom of the Eye Health Pyramid that serves a population of 50,000 people in a cluster of villages. Fifty percent of eye care is delivered right here. Started in 2002 by the L V Prasad Eye Institute at Chagaullu, a village in West Godavari, Andhra Pradesh, then with a population of approximately 20,000 people, the concept of Vision Center has since captured the imagination of eye care policy makers all over the world. Today, we have hundreds of Vision Centers; incidentally most of them are built and managed by the non-Government eye care organizations. I work with the Government of Odisha in the Universal Eye Health Program. I am happy that the Government of Odisha has established 60 Vision Centers in several districts of the state with standard equipment, trained manpower and sound resource allocation.
The world is committed to attain the 17 Sustainable Development Goals, the SDG, by year 2030. In order to do so, we need several transformations of the existing health care strategies. I suggest 3 transformational steps: Step One, at least double the health financing from the current 1.2% of GDP; Step Two, ensure that the scarce available resource reach everyone everywhere; and Step Three, provide appropriate and affordable care backed by adequate referral system. We take pride that we are the first country to recognize blindness and visual impairment as a health priority in 1976. But our cataract centric focus now must expand to the universal eye health coverage, UHC.
A comprehensive eye care is the basic tenet of UHC. Probably, we are getting there, but not reached yet. We need to accelerate our pace and all of our actions must also direct to improve people’s health seeking behavior. In my personal opinion, one-off mass screening and/or surgery particularly in villages accessible by reasonably good transportation system today only dampen the health-seeking behavior of people. A fixed facility manned by technical personnel trained for this purpose is the solution. This requires a change in administrative policy change and behavior change of care providers.
Government alone cannot do every thing. We need a Public Private Partnership for a Purpose. The purpose is both reducing blindness and same time empowering people. The VISION 2020 is building this bridge. Name VISION 2020 would change after year 2020; but not the mission. The WHO would soon disseminate the new World Report on Vision. This report would help redesigning country specific strategic to reach the sustainable development goals by year 2030.
Welcome the possibilities.
Thanks everyone for joining us in this journey.
Taraprasad Das, President, VISION 2020 INDIA
Selma Hembram, 68 hailing from Santhal tribe waited for 3 long years to regain her vision lost to cataract. Living in Sunderbans’ last hanging island, Patahar Pratima, separated by a deep forest and river, Selma did not have access to eye care facilities, but more importantly a qualified counsellor, who could address her fear of surgery.
A large number of West Bangal’s Sunderbans islanders face a similar fate. For them local traditional medical practitioners are the first contact and in several areas, the only. Commonly known barriers of lack of adequate health centres, awareness and health seeking behaviour afflicted Sunderabans, a short 2 hour drive from the Kolkata, the capital of West Bengal.
Some challenges however, are as distinctive to this island as its mangroves – geographical, communication, low population density, abject poverty and accessibility. The 52 inhabited islands of the total 106 are connected through rivulets, each rivulet the width of a river. Sightsavers had their task cut out for them when they launched their five year long ‘Eye Health Systems Strengthening Project’ from 2013 culminating in 2018.
In a significant impact the blindness prevalence in Sundarbans was significantly reduced to 0.7% as per the project’s end-line survey.
The prevalence of blindness in Sunderbans was a high 1.9%* – higher than the national average of 1.00 % as per the NPCB RAAB survey 2007, when the project was launched. (*As per the findings from the Sightsavers’ baseline survey 2014)
The ‘Eye Health Systems Strengthening Project’ aimed at addressing the urgent need for improving eye health in select blocks of North 24 Parganas and South 24 Parganas of Sunderbans Islands, West Bengal, India. The project was supported by Standard Chartered Bank as a part of their ‘Seeing is Believing’ campaign and was implemented in partnership with Southern Health Improvement Society-SHIS, Sundarbans Social Development Centre- SSDC and Vivekananda Mission Ashram-VMA) and the two district government hospitals.
“The project adopted a two pronged approach, providing primary eye care services to the community through Vision Centres, and strengthening the eye health system in the Sundarbans through developing a cadre of eye health professionals from the community. Sightsavers also supported infrastructural improvements within existing primary and secondary health centres, both at the government and non-governmental levels,” Said Mr R N Mohanty, CEO, Sightsavers about the project.
The project incorporated the provision of free corrective surgeries for specific categories, such as cataract cases among children and the elderly with financial difficulties in association the District Blindness Control Program. It provided access to affordable spectacles and supported school screening and referrals. Moreover, vision centres at the block level played a pivotal role in the project. Capacity building activities for personnel associated with the project as well as those working on eye health within the local public health systems were also undertaken.
To a large extent, the objectives of the project have been achieved. As per the final project report, 392,117 adults were screened of whom 205,033 people refracted and 30,814 provided with cataract surgery; 448,617 school children screened and 7637 received free spectacles. Ninety nine (99) children with congenital cataract also received appropriate surgical intervention.
Beyond the number crunching, the project has created a lasting environment of awareness, of changed perception and built trust among people of the islands towards eye health seeking behaviour. “When we arrived in Sunderbans, people did not trust us. They would rather believe their traditional healers,” shares Dr Asim Sil, Medical Director, VMA, one of the implementing partners. “But some successful surgeries later, we were able to win the trust of the islanders. If we planned to get 30 patients finally 45 patients would arrive. The extra patients would push themselves in the already crowded bus to seek treatment.”
To cater to the population in Sundarbans, the project has developed 17 vision centres housed at blocks with trained cadre to man. The core of every vision centre was based on the concept of sustainability which aimed towards generating enough revenue to be able to support the expenses like running cost of VC, salary of one VT and one community health worker.
Talking about the mantra towards achieving the set goals, Dr Sandeep Buttan, Global Technical Lead- Eye Health (Asia), Sightsavers said, “We realised that if a district level impact is desired, an intense pan district program involving all players (eye health and others) is essential. The intensity of our intervention was much higher than elsewhere! There was strong focus on creating lasting behaviour change and generating evidence for impact.” “Every block was targeted for interventions including vision centres in each of them and use of GIS technology for planning and monitoring. Very close follow up of activities and outcomes, every month.”
“It was a wonderful experience of team work with 3 partners along with Sightsavers. It was a cohesive unit and we all worked in a seamless manner,” was the lasting impression shared by Dr Asim Sil.
Here is the story of an old couple, who lost their sight due to cataract and suffered life with vision loss for three long years. Years during which they lived alone and survived only due to their love for each other.
What was needed was a simple surgery. This is the fate of the unreached in India who need not be blind. But fortunately there are organizations who are there to help.
For Gafoor, 80 years old and Shahidhan, 75 love for each other was, perhaps, the only reason that gave them a motivation to live and face the dark drudgery of life with stoic silence.
In their over 60 years of married life, the couple, living in rural Uttar Pradesh, had their share of ups and downs in life and it had more often than not been a struggle. But their love for each other was never put to the test more than in the last few years. A difficult life of surviving on daily wages earned by them became all the more challenging when they gradually started losing their sight.
When their vision diminished further and they became blind, life became a nightmare for the old couple. They approached each day with trepidation. With their vision gone, each simple daily chore that earlier was simple, seemed insurmountable. Even moving around the house was a challenge. Menial tasks like cleaning, washing or going to the toilet started becoming impossible. With no children or relatives to help, for over three years the couple were dependent on the goodwill of the villagers who dropped in occasionally to feed or clean up the couple.
Fortunately their fate took a turn towards sunshine as the Hospital Based Community Eye Health Project implemented by Operation Eyesight in collaboration with Dr. Jawahar Lal Rohatgi Eye Hospital in Kanpur District, Uttar Pradesh was God-send for the couple.
During a door to door survey which was conducted in the project target area to identify those with eye problems and at risk of going blind, the Community Eye Health Workers were shocked to find the couple covered in filth.
The Community Health Workers assessed the vision of the old couple and diagnosed them with being blind due to cataract in both the eyes. The couple were counseled to undergo surgery at the hospital free of cost to them.
However, the couple who had supported each other morally for the past three years were apprehensive to leave each other alone for the fear that the other person may not be able to survive. They told the Community Eye Health Workers that they would rather die blind together than be separated.
Nivedita, the Project Coordinator and Dr. Shivam Maini the Project In-charge and Ophthalmologist at the hospital visited the couple and assured them they both would be taken to the hospital and both would undergo surgery on the same day and brought back to their home together.
Convinced, the couple consented and underwent surgery for one eye and after a month for their second eye. Post surgery they regained their vision. They are now very happy and self dependent. Gafoor can now take care of his wife well. Shahidhan is able to look after their house and even manage to cook food. They stated that that being blind although was a terrible nightmare, just being together helped them overcome their sorrow. And they readily agreed with Dr. Maini that the only thing that should be blind is love!
An Interview with Mr Peter Ackland, CEO, IAPB
T he 66th World Health Assembly (WHA) concluded on 27 May, 2013 with agreement on a range of new public health measures and recommendations aimed at securing greater health benefits for all people, everywhere.
At the WHA “Towards universal eye health: a global action plan 2014-2019” – was endorsed by delegates. This is an action plan that aims to further improve eye health, reduce avoidable visual impairment and secure access to rehabilitation services. The global target is to reduce the prevalence of avoidable visual impairment by 25% by 2019.
Mr Peter Ackland, CEO, International Agency for Prevention of Blindness ( IAPB) was at the WHA. We posed some questions to him to understand the global action plan better and what it means for India. Following is the text of the Q and A with Mr Peter Ackland.
V 2020 India: The global action plan 2014-2019 towards universal eye health for all was endorsed during the recently concluded WHA. This is a big achievement for the eye care fraternity. Can you share with our readers the importance of the action plan, especially with year 2020 approaching?
Peter Ackland: The new Global Action Plan (GAP) is now the most important strategic document that we have in the field of eye health at global level. It builds upon and replaces previous VISION 2020 and 2009 – 2013 Action Plans. It is important because it keeps eye health and the elimination of avoidable blindness and visual impairment on the radar of health policy makers. With so much current international interest in the Neglected Tropical Diseases and the four priority non-communicable diseases (cancer, respiratory diseases, heart diseases and diabetes) we have to fight for attention for our cause of better eye health.
V 2020 India: What are the unique features of this action plan?
Peter Ackland: The GAP has an overall target – which is to reduce the prevalence of avoidable visual impair-ment by 25% by the year 2019 from the baseline of 2010. This is important as once achieved it will continue the downward trend we have seen in the age standardised prevalence rate of both blindness and moderate & severe visual impairment in the period 1990 to 2010.
The GAP is structured around three clear objectives:
The first objective focuses upon generating evidence on the magnitude and causes of visual impairment and on the state of eye health services and using this evidence to advocate for greater political and financial commit-ment by national governments to eye health.
Objective two encourages the development of policies, plans and programmes to enhance universal eye health. It refers to the need for integration of eye health into strengthened health systems.
Objective three stress the need for multisectoral engagements and effective partnerships.
Each objective has a number of proposed actions for national governments, the WHO Secretariat and Interna-tional Partners – IAPB and VISION 2020 India would fall into this latter group.
Overall the GAP summarises well current thinking within IAPB and its’ Members as to how we are most likely to raise the profile of eye health, vision impairment and rehabilitation and establish the services required to bring eye health to the most marginalised and poorest groups in society.
V 2020 India: Can you briefly describe the steps towards drafting the action plan and who all were involved in the entire exercise?
Peter Ackland: The first important step was that made at the World Health Assembly Executive Board meeting of Jan 2012 when a decision was made to ask the WHO Secretariat to prepare a new Action Plan to succeed the 2009 -13 Action Plan. A few months prior to this meeting IAPB had established a work group to advocate to Member States represented on the Executive Board for a new Plan, so we were very happy with this outcome. The WHO then prepared a discussion document and invited stakeholders to express their views as to what should be included in the new Action Plan. IAPB and many of our Members responded to this online consulta-tion. At the World Health Assembly in May 2012 the Australian delegation and IAPB hosted a lunch time semi-nar which was very well attended. By June, WHO had posted a “zero draft” of the new Action Plan and estab-lished a web-based consultation process. By September the “First draft” had been prepared followed by two a web-based consultation process. By September the “First draft” had been prepared followed by two meetings in October where Member States and NGOs in official relations with WHO, including IAPB, were able to comment on the content and the targets. The penultimate draft was then prepared for the Executive Board meeting of January 2013 where it was heartily endorsed and recommended for adoption. This subsequently happened at the WHA in May 2013.
Overall the consensus has been that the process was genuinely consultative, that views and comments were taken on board throughout the process, and that the final draft adopted at the WHA was very good content wise.
V 2020 India: The preparation involved several stakeholders. Were there any challenges that you faced while the proposal was being drafted?
Peter Ackland: The key challenge was to ensure that the process to develop and promote the new GAP was driven by Member States. WHO has over the past couple of years been engaged in a reform process that has stressed that the WHO is accountable to the 194 Member States and not to civil society or private sector interests. Thus it would have been counter-productive if IAPB had been seen to be at the forefront. Accordingly our advocacy strategy was to build relationships with Member States and encourage them to promote the GAP at the meetings. At this point I should pay tribute to the work of Lesley Podesta, the Chair of the IAPB work group, and Sanjeev Commar, a consultant engaged to help with the work in Geneva – both know the WHO system very well and their political antennae meant we were able to get the balance right. At the IAPB 9th General Assembly in Hyderabad in September 2012 VISION 2020 India arranged for us to meet senior Indian government officials and we were able to talk about the new GAP. Likewise we met the high level Chinese delegation that attended the 9GA. Getting the support of these countries and the leadership displayed by Australia, Mexico and Saudi Arabia in particular was the key to success.
V 2020 India: You in your blog have mentioned that now it is time for implementation. So what are the next steps? And how will this plan be implemented universally?
Peter Ackland: Important though the new GAP is it will only add value if it is now taken up seriously at country levels and national governments take responsibility for implementing the GAP in their country. Future IAPB advo-cacy work will now shift to country level – though we would hope all countries will take action the reality is that if we are to make impact on the global prevalence of blindness and visual impairment some big countries just have to succeed.
Very obviously India would be amongst those important target countries where we must see real progress. To this end we are lucky to have VISION 2020 India that is already well established in-country, plus a positive relationship with the government and many eye health leaders and champions. The development of eye health already in-cluded in the 12th National five year plan of India already lay a good foundation for implementing aspects of the new GAP. Unfortunately in many other countries these coalitions and plans to promote eye health are less well es-tablished. Part of IAPB’s future role will be to help establish strong local capacity to advocate for change.
We have been discussing with WHO how we can catalyse local interest in the new GAP. One thing we have thought of is to encourage the development of an approved WHO eye health service assessment tool which can be used in each country as a situational analysis of current provision and identify areas that need strengthening. Another proven approach has been to encourage localised prevalence surveys, such as RAABs. Global data or even national level data in big countries like India, can easily seem distant to policy makers and politicians whilst a local survey that identifies the size and causes of blindness and visual impairment is harder to ignore and more likely to interest people to want to do something about the situation.
V 2020 India: Vision 2020 India participated toward preparing the draft proposal along with other Vision 2020 programmes. What role do you think all the Vision 2020 programmes around the world can play to take this for-ward? What are the steps that they can take to successfully implement this action plan?
Peter Ackland: Local advocacy to promote national implementation of the new GAP is the key to success. The national VISION 2020 bodies are perfectly placed to be the organisations that lead the advocacy in their country. To a large extent advocacy work is very locally based – it is about knowing how political and policy decisions are made and who the key people are to build relationships with and to seek to influence. Much of this is culturally specific. There is no way that this can be led from outside the country.
Though IAPB can share resources and promote learning useful for advocacy based upon experiences of VISION 2020 organisations across different countries, ultimately it is local action that will win the day for us. These are exciting times and the new GAP provides us with the opportunity to make a lasting impact – I hope everyone reading this will feel they have something to offer to make this all happen – because you all do!
V 2020 India: Thank you Mr Ackland.
National Trachoma Survey: an interview with Dr Praveen Vashist
V 2020 – India: Why a survey on Trachoma?
Dr Praveen Vashist: According to the World Health Organisation (WHO) India is one of the endemic coun-tries for Trachoma. The last national survey was done in 1986 – 89. It is more than 25 years, a period in which a number of socio-developmental and trachoma specific SAFE initiatives have been taken to reduce the burden of the disease. It is time to conduct a mega survey to assess how these initiatives have impacted and to find out the current preva-lence and magnitude of trachoma in the country.
V 2020 – India: Has the disease not been eliminated from the country?
Dr Praveen Vashist: Though the burden of disease is reduced but there are still some high risk areas for trachoma. Dr RP Centre did a sur-vey in Nicobar Island of Andaman and Nicobar Island in 2010 and nearly 50% children were identified with active trachoma infection and trachomatous trichiasis was also ob-served in adults in all the ten villages surveyed, wherein trachoma control measures were suggested in form of mass Azithromycin treatment once in a year for three consecutive years. We conducted a repeat survey after three years in 2013 and found that the prevalence of active infection has come down to 6.8% amongst the surveyed children.In our Rapid Assessment of Trachoma (RAT) in urban slums of Delhi, we found active cases of trachoma in few slums although the magnitude of active trachoma infection was low.
V 2020 – India: For the current survey which are the states that you have selected?
Dr Praveen Vashist: We are conducting the tra-choma prevalence survey in 9 districts of 5 states which were part of the previous TRA survey in 2006 – 07. The 5 states are: Punjab, Haryana, Rajasthan, Gu-jarat and Uttarakhand. Uttar Pradesh was part of the 2006 – 07 survey, but Trachoma prevalence study has already been conducted by NPCB in this state.
The districts to be covered are:
Hoshiarpur (Punjab), Mahendergarh & Mewat (Haryana), Bikaner, Dholpur & Tonk(Rajasthan), Pauri Garhwal (Uttaranchal), and Kutch & Banas-kanta (Gujarat).
Additionally, 15 districts in 15 states will also be covered where a rapid as-sessment of trachoma will reflect the current status of trachoma in these regions.
V 2020 – India: What is the sam-pling frame/size for the survey?
Dr Praveen Vashist: For the Trachoma prevalence survey, we have selected 20 clusters randomly from each district. In each cluster minimum 100 children are examined: 1- 9 years for active infection and population of 10 years and above examined for
trichiasis, corneal opacity including blindness.
V 2020 – India: Dr Praveen, you have led several surveys, including the one on trachoma in Andaman and Nicobar. So drawing from that experience what do you bring different to this survey?
Dr Praveen Vashist: In one word: quality. We are concerned about quality and are making all efforts to ensure that we maintain standards as per WHO guide-lines. We are also conducting microbiological investi-gations among the cases as well as equal number of controls. Direct Immunofluorescence analysis will be done using the MicroTrak Chlamydia trachomatis Specimen Kit procured from M/s Trinity Biotech, IreDirect Specimen Kit procured from M/s Trinity Biotech, Ireland in the dedicated trachoma lab of ocular microbiol-ogy unit of Dr. R.P.Centre.