NATIONAL 6 -(Spotlight Weekly)]

Combating Blindness

Eye Camps have been conducted in different rural parts of the country where permanent eye care services are non existent

By AKSHAY SHARMA

Nepal like any developing country suffers from the triad of poverty, ignorance and disease. To combat eye disease we need more than just health workers. We also need good and easy methods of delivery of services. Experiences have shown that in developing countries like Nepal 80 % of ocular disease are preventable or treatable by simple means and at low cost. Local personnel drawn from local people and suitably trained in basic skills of primary health and eye care will be able to manage a high proportion of common illness and therefore more effective than a distant well equipped hospital.

An eye camp held in Okhaldhunga : For better vision

The National Program on Prevention and Control of Blindness was established in 1980 with the aim of achieving national self reliance in the field of opthalmology.

Pointing out to the not very long history of eye care in Nepal Dr R P Pokhrel reminded that there were only 7 ophthalmologists and only a few beds available for eye patients in Nepal, when he started eye care service at Bir Hospital. The magnitude of the problem of blindness was very high at that time and it was realized that it was impossible to overcome the problem of blindness merely depending on Government support only.

"This project has been against blindness particularly to the unreachable and unserved population and for the improvement in the quality of eye care together with the strengthening of training and educational activities," said Dr S.P. Lakhey, General Secretary Nepal Netra Joyti Sangh.

A nation wide survey on blindness was carried out from Dec 1980 to April 1981 with the financial assistance provided by the Netherlands Government through WHO. Technical assistance was also provided by Seva Foundation and a variety of experts, ophthalmologist from Nepal and from other countries were involved.

The survey showed 0.84% of the population were blind in both eyes. But out of these blind people nearly 80% are curable or suffer from preventive blindness. The number one cause of blindness in Nepal is cataract and its sequel and it is nearly 72%. The pattern of eye disease observed is typical of deprived society.

"The funding for blindness prevention is scarce and with great many health problems needing attention, eye care often gets little attention and support," says Dr Lakhey.

HMG, WHO and National and International NGO's have been very actively involved in clearing cataract backlog. The incidence of cataract in Nepal is 16,000 per year. As per facilities that could be available the WHO project organized eye camps up to the extent of 80 - 90 camps per year in the previous year and this helped in clearing cataract backlog from 22,00o - 26,000 each year.

Before the start of the project there were only 7 eye surgeons and most of them were working in Katmandu. With the beginning of the WHO project, the scholarships from WHO and others helped to send medical graduates for post graduates in India and other countries. Now there are nearly 84 eye surgeons in the country. As the eye surgeons were not enough an alternative to reach rural areas was sought and thus paramedical like Opthalmic Assistants were trained in three batches. In total 120 personnel were trained as Ophthalmic Assistants and some of them have left the job for other better opportunities. "These ophthalmic assistants are the key persons in the eye care system linking community care with specialist services," said Dr Lakhey.

A suitable system of health delivery in countries like Nepal should be affordable to the country and acceptable and accessible to all of it's people. It should comprise all levels of health care with a well structural referral chain allowing transferable from primary community level through secondary services up to tertiary care for those who need it.