|
|
Outreach programmes
The developing countries provide a specific
situation for eye care delivery system. While in urban areas there
is access to medical institutions, the remote, isolated areas stay
without it. Therefore, the idea of outreach programmes has been put
into being.
There are two types of outreach eye care delivery
system – hospital-based and field-based. The first one –
screening camps, is arranged
within a short distance from the base hospital. A team of ophthalmic
assistants travels to a neighboring village (2-3 hour drive), where
they perform routine eye examination. Minor ocular diseases are
treated on the spot, whereas those complicated or requiring surgery
are referred to the hospital.
|
The other one -
surgical camps are always a big venture. It
has to be remarked that before each camp, either
screening or surgical, a prior appropriate
reconnaissance on the spot must be carried out
(population evaluation and advertising in collaboration
with the local community activists). Only providing that
these actions are undertaken the venture has a chance of
success. Getting to the very camp area is frequently
adventurous, and at times may become hazardous because
of the off-road conditions as well as the local
insurgency. |
Getting to the camp area (Nepal) |
|
The medical team uses all kinds of
means of transportation i.e. planes, jeeps and porters.
Sometimes an arduous trek must be undertaken. Once the
team arrives, a temporary hospital is arranged in a
public building (ex. a school building). Different rooms
play a role of a registration, outpatient department,
anesthesia room, operating theater and postoperative
ward. |
Patients (Nepal) |
|
Frequently a power generator is used since the electricity often
goes off. It also happens that the surgery is completed under
torchlight. A team of 10-12 personnel (1-2 surgeons, 3-5 ophthalmic
assistants, 1-2 ophthalmic nurses, drivers, helpers, a cook, etc.)
is able to screen 800-1200 patients and perform 100-400 surgeries
within 4 days. In previous years different authors reported poor
outcome of surgical outreach programmes. Although we have
not done any formal research in this field, from our own
experience we are convinced, that these findings are no
longer up-to-date. These days the successful treatment
during a surgical camp is a result of following a strict
protocol of procedures (appropriate sterilization,
disinfection, surgical technique, etc.). |
Cataract surgery (Nepal) |
|
Patients being instructed how to use medicines (Nepal) |
The complete
study of management of eye care in a developing country (on the
example of Nepal), including the management of modern eye camps, has
been contained in the publication of the Tilganga Institute of
Ophthalmology, entitled “Fighting Global Blindness”. However, not
only procedures but also the dedication and high motivation of the
medical team play an important role in the final success. On the
other hand, it is imperative to say that even well managed eye camps
are not a perfect solution for patients inhabiting rural areas of
developing countries. The perfect solution will always remain the
permanent access to a stationary eye clinic with an ophthalmologist
as well as appropriate medical equipment on the spot.
|
