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Fighting cataract blindness in developing countries

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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.

 

     
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