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PROCEEDINGS OF THE XV ANNUAL CONFERENCE
NATIONAL SOCIETY FOR THE PREVENTION
OF BLINDNESS-INDIA
&
XIV NATIONAL SYMPOSIUM
ON
“ROLE OF
VOLUNTARY
ORGANISATIONS
IN PREVENTION AND TREATMENT
OF CURABLE BLINDNESS”
June, 10th & 11th, 1979
Edited by :
PROF. S. S. GREWAL
Secretary
Ludhiana District Branch N.S.P.B,
Organised by:
Department of Ophthalmology
DAYANAND MEDICAL COLLEGE & HOSPITAL
LUDHIANA.
xvth
to- >.
NATIONAL 5OCICTV fOR.
Depth
Of
Ophthalmology,
THE
Orj'txn Inc ci I>y 1
DAYANAND
MEDICAL
COLL
10th & llth June 19.9.
-
COMMUNITY HEALTH CELL
326, V Main, I Block
Koram.ngala
Bangalore-560034
India
CONTENTS
Welcome Address
1.
2.
5.
6.
7.
Page
1
Tnaguration
3
Annual Report
Dr, U.C. Gupta
Symposium
“Role of Voluntary Organisations in
Prevention and Treatment of Curative Blindness".
5
Role of Scientifically Conducted
eye camps.
Scientifically Conducted Eye-Camp
(P.G.I. Pattern)
3. ' The Role of Scientifically Conducted
Eye-Camps in Prevention and Treatment
' of Curative Blindness.
4-
Prof. S.S. Grewal
(Organising Secretary)
Role of Scientifically Conducted eye care
camps.
Dr. B. Shukla
10
Prof. I.S. Jain
13
Dr. R. Daniel
Dr. S.K. Chopra
Prof. A. Chatterjee
16
Dr. K. Lal
21
Role of Teachers and Parents in Prevention
and detection of eye diseases.
Prof. S.S. Grewal
25
Role of Teacher and parents in Prevention
and Detection of eye diesases.
Dr. T.K. Chaku
30
Mobilisation of Voluntary Organisations
for Prevention and Treatment of curative
Blindness.
34
Prof. Madan Mohan
8.
9.
Role of Trade Unions and Employers in
Prevention through health Education.
Dr. R.N. Slid
36
Role of Rotary Clubs in Prevention of
Blindness.
Dr. N.K. Bhatnagar
40
10. Role of service organisations such asLion
Club, Rotary Club, Indian Red Cross and
Panchayats and Mohalla Sudhar Committee
in Prevention and Treatment of Curative
Dr. M. Mathew
Blindness.
Dr. P.S. Sandhu
44
11. Role of Charitable and Religious Institutions
in promotion prevention and treatment
of curative Blindness in rural areas.
Dr. N.S. Baweja
49
COMMUNITY HEALTH CELL
€7/1, (First Flou .13. LLt.-ita nOad
- COL 031
PARTICIPANTS IN THE
XIV NATIONAL SYMPOSIUM ON
“role of voluntary
'
organisations
IN PREVENTION AND TREATMENT
OF CURABLE BLINDNESS”
1.
Dr. B. Shukla
Reader in Ophthalmology,
G.R. Medical College, Gwalior.
2.
Prof. I.S. Jain
Prof, and Head, Deptt. of Ophthalmology,
P.G.I. Chandigarh
3.
Dr. R. Daniel
Dr. S.K. Chopra
Prof. A. Chatterjee
Deptt. of Ophthalmology
C.M.C. & Brown Hospital,
Ludhiana.
4.
Dr. K. Lal
Director, National Programme for Prevention of Visual
Impairment and Control of Blindness, New Delhi.
5.
Prof. S.S. Grewal
Prof. & Head, Deptt. of Ophthalmology,
D.M.C. & Hospital, Ludhiana.
6.
Dr. T.K. Chaku
Senior Lecturer, Deptt. of Ophthalmology
C.M.C. & Brown Hospital, Ludhiana.
7.
Prof. Madan Mohan
88.
Dr. R.N. Sud
Prof, of Ophthalmology. Director .
Dr. Rajindra Prashad Centre for Ophthalmic Sciences,
New Delhi.
Associate Prof., Deptt. of Ophthalmology,
D.M.C. & Hospital, Ludhiana.
9.
Dr. N.K.. Bhatnagar
Eye Surgeon.
Railway Hospital. Allahabad.
10. Dr. P.S. Sandhu
Dr. M. Mathew
Deptt. of Ophthalmology,
Lady Hardinge
Medical College & Hospital, New Delhi.
11. Dr. N.S. Baweja
Eye Specialist, Jullundur.
Report on XVth Annual Conference of N. S. P. B. India Held on
10th & 11th June 1979 at Ludhiana.
WELCOME ADDRESS
(ProfS. S. Grewal)
XVth Annual Conference of National Society for the Prevention of Blindness India,
Organised by Department of Ophthalmology, Dayanand Medical College &
Hospital, Ludhiana, was held on 10th & 11th June, 1979. Over 75 delegates from all
over India attended the conference. Before welcoming the delegates Prof. S. S. Grewal,
Organising Secretary, introduced the Chief Guest, Dr. P. N. Chhuttani, President
of National Academy of Medical Sciences. He also introduced Dr. Sushila Nayar,
President of NSPB, Dr. L. P. Agarwal, Vice President, Dr. U. C. Gupta, Secretary
and Dr. M. R. Chaddah, Secretary, Panjab State Branch of NSPB.
“Prof. P.N. Chhuttani, Dr. Sushila Nayar, Prof. L.P. Agarwal, fellow delegates
ladies and gentlemen. It is my proud privilage welcome you all to Ludhiana for
XVth Annual Conference of NSPB and XIVth Symposium “ROLE OF VOLUNTARY
ORGANISATIONS IN PREVENTION AND TREATMENT OF CURABLE
BLINDNESS”.
Ludhiana essentialy an industrial town is famous for its hosiery and woollen
goods and a visit to Ludhiana is not complete unless these wollen mills are visited
specially by ladies. It has also progressed in the field of cycle and steel industry.
The agricultural university which is venue of our conference is a pride of Ludhiana!
It has brought green revolution to the state which is feeding half of India. Besides
this it has a beautiful and colourful campus. Visiting this campus one cannot imagine
that Ludhiana also happens to be a congested industrial town. Ludhiana is a great
educational centre besides over a dozen arts and science colleges we have an
engineering college, college of education & two privately run medical colleges. Public
of Ludhiana has been rendering medical services to suffering humanity through
these two medical institutions.
In our programme of prevention and cure of blindness team spirit between
public and medical men has played a great role. We are lucky that we are in a
ideal situation to render eye care service to the remotest part of this district because
1
of good road system, quick and frequent bus service and awareness of public about
their eyes and most of all, co-operation and help of service organisation like Rotary
Club, Lions Club, Jaycee’s and various other charitable organisations. Such organi
sations have also helped us to look after the eye care of school children where we can
create consciousness specially in rural children about cleanliness and importance
of eye.
State branch of NSPB was started at Amritsar one and a half years ago under
the able stewardship of our state secretary Prof. M. R. Chaddah. This membership
has increased to over 400 out of which 80 are life members and it held eye camps
during the last year in collaboration with rotary and lion club and D.M.C. Ludhiana
branch of NSPB was started only last month under the presidentship of our very
able dynamic and likable deputy commissioner Sh. G. S. Cheema.
This conference will help us all to share our experiences in the field of preven
tion and cure of blindness and to discuss our difficulties in dealing with such a
health problem. Let us not concentrate our energies on just holding eye camps, but
we should in the international year of the child lay stress on as to how we can preserve
a good eye sight of our children and prevent the preventable. This aspect I feel
has been neglected so far and I hope through our discussion you will be able to
suggest some concrete steps to this end. This conference has also given us fellow
Ophthalmologists and social organisations an opportunity to develop friendship,
fellowship and good will.
We were given only 6 weeks for holding the conference and we have to shift
the date by one day as desired by our president and vice-president. Any inconvenience
in this change of date caused to some members is regrettable. I hope you have a
comfortable stay here and will go back with hot memories of Ludhiana. Those of
you who attended All India Ophthalmological Conference in Amritsar will know that
Punjabi’s are not only brave in the cold but also brave in this intense heat.
I once again welcome you to this conference and sincerely hope that you will
overlook any short coming in your brief stay here. I wish you good and pleasant
time ahead. In the end Prof. P. N. Chhuttani, I welcome you once more and I am
grateful to you for accepting our invititation to inaugurate this conference.”
2
Prof. P.N. Chhuttani President National Academy of Medical
Sciences Inagurating the Conference
Inaguration
I
Dr. Sushila Nayar President N.S.P.B. India
Chairing the Symposium.
Prof. L.P, Agarwal reading the progress
report of National Plan
In his inaugural address Dr. P. N. CHHUTTANI said “India had the dubius
distinction of having he largest number of blind people in the world. In Punjab
and Haryana, the blind constituted about 3 percent of the total population. This
number included a large number of women. According to a survey conducted at the
P. G. I. the financial loss because of the incapacitation of such a large number of
people amounted to over Rs. 100 crores per annum. Medical colleges in Punjab and
Haryana could play a big role in the eradication of blindness from these States. We
should implement the 20 years programme to eradicate blindness launched by the
Govt. National Plan”.
Dr. SUSHILA NAYAR in her address thanked the organisers for hosting the
conference at such a short notice. She stressed the role of voluntary organisations in
the prevention & treatment of blindness. She said that the eye sight of the 95 percent
of the blind in.the country could be restored. She maintained that small-pox, one
of the major causes of blindness had been removed from the country and now only
malnutrition was to be tackled.
Dr. L. P. AGARWAL, disclosed that the department of Ophthalmology of the
medical college will be converted into the departments of community Ophthalmology
and provided with additional equipment in a phased manner under the National
Plan. After that Dr. U. C. Gupta, read the annual report of j the society.
Mr. G. S. Cheema, Deputy Commissioner, Ludhiana and President of District
Branch of NSPB, thanked the chief guest for inaugurating and the delegates for
attending the conference.
After the inaguration ceremony, coffee break & photograph, the XIVth symposiun
“ROLE OF
VOLUNTARY ORGANISATIONS IN PREVENTION AND
TREATMENT OF CURATIVE BLINDNESS” was held. 13 papers by different
speakers were read. There was a good and healthy discussion after each paper.
After the evening session of symposium various meetings of different bodies of
NSPB was held. The conference recommended as follows
1.
In this International Year of the Child more stress should be laid on the
the eye care of school children. Schools should be supplied with free vision
charts and teachers should be taught to test the vision of the children.
2.
Theme for prevention of blindness week from 2nd to 9th Oct. will be “Help
Visually Handicapped Child.”
3
3.
Examination of three lacs population including rural population especially
school children and industrial workers.
4.
To establish District co-ordination committees with the Deputy Commissioner
as its chairman for regulation and the working of various eye camps held in
the districts so that the quacks arc forbiden to hold eye camps.
5.
To hold 200 eye camps and operate 5000 eyes.
6.
To enroll institutional members, like factory and other institutions, of the
society.
7.
Establishment of community Ophthalmic Research Centres.
Delegates were entertained to a cultural programme at the open air theatre
a t Punjabi Bhawan in the evening. The drama “Mard aur Aurat” by Mr. Harpal
Thiwana was very well appreciated by the delegates and Dr. Sushila Nayar, President
of Society congratulated Mr. Thiwana for putting up a wonderful show. Later
on delegates were entertained to dinner at residence of Dr. S. S. Grewal, where
delegates had opportunity to meet the citizen of Ludhiana and after dinner speeches
by Dr. Bhatnagar, Dr. Madan Mohan, Dr. S. S. Grewal, Dr. Mrs. Bajaj and Mr.
G. S. Cheema the conference came to end as Dr. Grewal informed the delegates
that since there were only two papers left for next day, they should be taken as read.
He again thanked the delegates for making the conference a success.
4
community HEALTH
326. V Main, I Block CELL
Koramonga)a
Bangalore-560034
India
Annual Report For The Year 1978
Presented by Dr. U. C. Gupta Secretary General
Hon’ble Chief Guest-Dr. Chhuttani, Madam President, Respected Dr. Agarwal,
President Ludhiana Branch.- Shri Cheema, Dr. Geewal, Respected Guests, fellow
delegates and gentlemen.
It is with great pleasure that I present one report for 1978 of the National
Society for the Prevention of Blindness. The detailed report has already been
circulated to the members for their scrutiny and comments. At this moment, I
propose to highlight only the important aspects of our activities during the year
under report.
BRIEF HISTORY OF THE SOCIETY :
We are all aware that loss of sight is one of the greatest tragedies that could
befell a human being. This human tragedy is further compounded with the economic
repurcussions not only on the individual but also on his family and imposes a
particularly heavy burden on the Society at large. According to the W. H O.
estimates, there are about 27 million blind in the world. India alone accounts for
about 9 million i.e. one third of the estimates for the whole world. In addition there
are about 45 million people who have impaired vision but not blind.
Before the establishment of this Society, there was hardly any organisation
working in the field of prevention of blindness. At the 1959 convention of the
National Association for the Blind, idea of forming a National Society for the
Prevention of Blindness, was conceived by Late Dr. Mohan Lal of Aligarh. It was
blessed by the Govt, of India and the Society got registered on 24th August, 1960
under the Society’s Registration Act 1860. The Society has the honour of having
elected Late Pandit Jawahar Lal Nedru as the first Chief Patron. The then Union
Health Minister Late Smt. Rai Kumari Amrit Kaur, was the first President arid Late
Dr. S. N. Mitter was the first honorary Secretary of the Society. In june 1964, our
present President. Dr. Sushila Nayar took over as President since she succeeded
Smt. Raj Kumari Amrit Kaur as the Health Minister. In March 1965, Prof. L. P.
Agarwal, was elected as the Honorary Secretary. Under the able guidance of Dr.
Nayar as the President and under the dynamic leadership of Prof. Agarwal as the
5
Secretary the Society grew in stature and registered healthy developments. Tn 1977,
Prof. Agarwal was elected as the First Vice-President and I took over as 'he Secretary
General.
PRESENT STATUS
The Society has now successfully entered into its Nineteenth years. Its net
work has spread to 17 states resulting in formation of State Branches. Some of the
State Branches have been able to establish District Branchas which are 37 at
present. Uttar Pradesh State Branch has established six district branches during
the year and more are in proccessing. Some of the State Govts, being aware of the
magnitude of problem have taken initiative and issued directive to their Civil
Surgeons and Chief Medical Officers to help in forming district branches of the
Society to tackle the problem of blindness. By organising State and District Branches,
the Society hopes to spread its activities throughout the whole country so that not
only the objects of the Society are achieved, the Society could also usefully contribute
to the effective implementation of the National Programme for the Prevention of
Visual Impairment and Control of Blindness launched by the Govt, of India on the
recommendations of this Society.
OUR MEMBERSHIPS
The year under report has registered appreciable increase in the membership
in comparison to the previous year. According to the information made available
by some of the branches and considering the direct membership, our strength on
31 st Dec, 78 was 738 life members, 2120 ordinary members and 342 institutional
members against 343 life members, 1823 ordinary members and 238 institutional
members in the previous year. Reports from some of the branches are still awaited.
It is hoped that our total membership is near about 5,000.
OUR ACTIVITIES
The Society functions in close collaboration and with participation of its State
and District Branches and carries out activities at the Headquarters at Delhi as well.
The Society has been actively engaged in various projects. This year greater stress
was laid on holding more eye camps and bringing out educational material. As per
reports received, 96 eye camps were organised in the year, where about 2 lakh persons
were examined and 23,800 operated. The most encouraging feature of the camps
was that they were just not Cataract oriented camps. Proper follow up facilities
6
were ensured and comprehensive eye health care services rendered to the community
as far as practical.
Society lays greater priority to the preventive & promotive aspects. It is well known
that large percentage of blindness is preventable and blindness can be avoided if the
community at large is made aware of the problem and advised to take right attitude
towards the eye diseases. The impairment of vision is not an Ophthxlmic problem
alone, it is very intimtely linked with the socio-economic and cultural fabric of the
community. Thus mere development of the Ophthalmic Services only will not help
tackling the problem until and unless standards of living of the masses also go up.
In order to bring scientific concepts to the masses, active health education is very
necessary. During the year under report, the society has given due priority to this
aspect and has brought out many educational aids. Various other publicity and
educational media like Radio & T. V., Press publictions, periodicals, exhibitions, film
shows and dramas etc., have been fully and effectively exploited by the Society’s
Headquarters and the State and District Branches.
Every year the Society holds a Symposium on an important aspect of the
problem and makes suitable suggestion and recommendations for implementation by
the authorities concerned. In 1978, the subject of the symposium was “Prevention
of Occupational Hazards in Industries, a cause of impairment of Vision”. The
participants of the symposium represented various professions and different levels of
administrative bodies. Their contribution reflected a wide range of interests and
richness of experience.
COMMUNITY RESEARCH
The Society encourages community Ophthalmic Research and has developed a
few centres. The centre at Modi Nagar in U.P. built with munificient grants from
M/s Modipon Ltd., and Modi Science Foundation is doing excellent work. The special
feature of the Centre is its location. Modi Nagar is an industrial area which provides
ample opportunity to study the ophthalmic problems of the Labour Community. With
the rapid industrialization in our country, the health problems of the labour call
for proper attention on our part. The Symposium of the year has made very useful
recommendations which will go a long way in dealing with the problem if accepted
and implemented by the concerned anthorities.
7
The other Centre under development is at Raison in Kulu district of Himachal
Pradesh. There it is mostly garden and quarry labour and their problem is different
than at Modi Nagar.
Another Centre has been developed at Moti Nagar in Delhi which is providing
goed research-cum-ophthalmic care to the people of that area who are mostly daily
wages workers working in Delhi.
Negotiations are in progress to establish a Centre at Faridabad.
Society has undertaken eye examination of School Children, College Students,
Industrial workers, D. T. C. Drivers etc. It has under taken survey of Blind Schools
with a view to determine as to how many blinds in different blind schools can be
restored sight by surgical interference and also if some Visual Performance can be
improved by low vision aids with a view to convert them into useful citizens.
The Society runs Optical Research Unit and a Contact Lens Research Unit at
Dr. Rajendra Prasad Centre for Ophthalmic Sciences at Delhi. These units are doing
very useful work and rendering service to the Community.
The Society also undertakes rehabilitation activities through its Centre at
Dr. Rajendra Prased Centre for Ophthalmic Sciences assisted by the Deptt. of Social
Welfare. The details have been given in the Annual Report circulated.
OUR FINANCES
The Society derives its financial support mainly from membership fee, muificient
donations by the philanthroptists and grants in aid from the Central and State Govts
received from time to time. The Royal Commonwealth Society for the Blind INLAK.
foundation and variovs National and International Social organisations support the
eye camps. The Society had a closing balance of Rs. 8,31,51 5/- on 31st December,
1 978 against Rs. 7,01,41 2/-at the end of 1977. The total assets of the Society at
present are over Rs. 4 0 lakhs.
SUM UP
This is a short resume of our activities during the year. The Society endeavo
ured its best to accomplish the set aims and objects. It has succeeded to an appreci
able extent in projecting its image in the minds of the people. Considerable degree
of success has also been achieved in carrying the message of eye health care in rural
areas. With the continued co-operation and unstinted support the Central Headquarter
is receiving from its branches and various other social and voluntary organisa-
8
tions, national and international organisations and the various concerned departments
of the Central and State Govts. I do hope, Society marches ahead to intensify its
activities and achieve its goal. The Society has taken up the challenge and I am
confident, it will accomplish the task assigned.
ACKNOWLEDGEMENT
I take this opportunity to thank the State and District Branches who have given
their whole hearted co-operation and shared my responsibilities. It was from these
branches, I drew strength as the Secretary General of the Society. Those branches
who could not be active during the year, I entreat them to please rise up to the
occasion and extend their active co-operation to meet the challenge, the Society
has accepted.
I would be failing in any duty if I do not express my gratitude to my President,
Dr. Nayar, under whose able guidance and leadership I functioned. I offer my
grattitude to the Vice-Presidents for all the encouragement, I received from them.
I would specially mention Prof. Agarwal, who inspite of his terribly busy schedule,
could always spare his valuable time to me to discuss important matters and gave
his guidance and advice with full understanding of my limitation and lack of
experience in administering a Voluntary Organisation.
I gratefully acknowledge the co-operation, I received from the Treasurer and
the Joint Secretaries of the Society.
For Dr. N. K. Bhatnagar, I have all administration for him the way he organised
the Symposium. It was a great success.
I am thankful to the Director, All India Institute of Medical Sciences, for
granting E. H. S. facilities to the N S.P.B. staff; and to the Chief Organiser, Dr.
Rajindra Prasad Centre for Ophthalmic Sciences, for the various facilities provided
to the Society at his Centre.
Last but most important, I express my sincere gratitude to the National Society
for the Prevention of Blindness Staff working in various projects. I would specially
mention my Executive Secretary-Shri Nirmal Singh and my Accountant-Shri A. P.
Bansal, for their valuable contribution.
I do admit the achievements have been very modest but appreciable. The
credit for all the achievement goes to all my colleagues at the Headquarters and at
State and Distrist Branches. I personally own full responsibility for all the mistakes,
short comings and acts of omission.
9
Role of Scientifically Conducted Rural Eye Camps In
Prevention of Blindness
(Dr. B. Shukla Secretary N.S.P.B. Madya Pradesh)
What is ideal is rarely practical. If one waits for the ideal conditions
to work such a situation may perhaps never come. Hence one has to strike a
compromise between the ideal and practical ; between quality and quantity. As
regards eye camps there are many people who hold extreme views. For many the
success of an eye camp is synonymous with the number of operations performed and
hence their target is to perform the greatest number of operations in shortest period
of time. Obviously such an emphasis on quantity would be at the cost of quality
with a high percentage of failure which is rarely accepted on the other hand about the
eye camps and consider it a sanctified quackery. They are not willing to accept any
thing less than the hospital standard of sterilisation and arrangements.
Inspite of some validity of the latter view when one considers the appaling
number of curable blinds in the country and the great paucity of hospital accommod
ation one cannot deny the justification of eye camps with all their drawbacks for
another 10 to 15 years. Nevertheless discrimination and caution are equally
essential to curb the over enthusiasm for raising the number of operations at eye
camps.
The concept of scientifically conducted camps implies service to adequate
number of persons without making much compromise with surgical priciples and a
good after care. It also enisages some dissemination of knowledge of eye care and
prevention of blindness to the area catered. As stated earlier this is not possible
with large eye camps or hurriedly organised camps. A prior detailed planning is
essential to get the maximum results.
Broadly speaking the eye camps can be classified as mini camps, average
camps and mass camps. The number in mini camps is usually between 30 and 50.
The average camps consist of 100 to 200 operations where as in mass eye camps the
10
NATIONAL SYMPOSIUM ON
'role of voluntary organisations
IN PREVENTION AND TREATMENT
OF CURABLE BLINDNESS'
number usually exceeds 500. Although there is a great back log for cataract
operations alone, to be scientific and well planned it is desirable to limit to mini
and average eye camps. To compensate for the number the frequency of smaller
camps can be raised.
One of the major defects in eye camps is improper sterilisation in operation
room. Although the operation theatre of a district or tahsil hospital would be ideal
at least the operation room of a primary health centre must be available. Rooms
of a good school building can also be converted into a workable operation theatre.
Operations under tents is highly undesirable.
Another source of infection are
flies and every possible method should be employed to prevent them. A small
plastic fly spat is a very useful tool for the rural theatre. Equally common source
of infection is due to free entry of organisers (non-medical), officers, leaders, press
men and photographers. This trend has to be strongly denounced although curious
enough some surgeons tend to encourage it. If no antibiotics are used the infection
rate in such camps would be little short of 100 per cent.
In many camps the surgeon waves his hand after taking out the knife from
the last case. At least the first dressing must be done by the senior surgeon and
further dressings for one week by a qualified assistant who should be capable of
dealing with the usual post-operative complications. Inadequate follow up care has
aroused much criticism of eye camps. At the time of discharge proper medicines
and instructions should be given and it is desirable to call the patients once again
after a month or so for follow up and glasses by refraction or subjective testing.
To many patients an ordinary +10D lens is far from satisfactory. Care of glasses
is as important as the care of eyes and hence should be properly explained.
Like the size of the camp the site of camp is equally important in conducting
it scientifically. Again there are two extreme views. Some people feel that for
proper sterilisation and cleanliness it is better to hold camp in cities or district towns
where all facilities are available. Others believe that the utility of the camp is more
served the more remote area is chosen. The basic idea of camps is to serve the
rural population and hence the purpose to some extent is defeated if it is held in
big townships, no matter how nicely they are conducted. At the same time it is also
true that in a very remote village it is virtually impossible to conduct the camps in a
scientific way for want of basic facilities unless huge sum of money is spent. Because
11
of lack or adequate transport facilities few people from the neighbouring areas are
able to take advantage.
It is therefore suggested that to be of optimum utility the camps should be
conducted preferably at Tahsil level, or in a small district or a large village a little
away from the main township. At a relatively bigger place there are educational
institutions where talks on eye care and prevention of blindness can be arranged or
vision testing can be taught and conducted. For the camps usually adequate care
is taken of the surgical team and it is rather unfortunate that in most camps the
services of social workers is not utilised who can give general guidance to patients
and their relatives and spread eye care information in the township in general.
For scientific camps arrangement of cots is desirable. It ensures proper
spacing, limits contamination from the ground dust and prevents the surgeon from
getting a severe backache after the dressing. This would be only possible if the
number is not too large and the place is not too small. Application of corneo
scleral sutures in camps is controversial subject. Many surgeons depend on a
large conjunctival flap for healing and in large camps this perhaps not possible for
want of time. Nevertheless it can not be disputed that even if one corneo-scleral
suture is given in each case the results would be certainly better and if the number
of patien.s is not too large it should not be difficult.
From the above discussion it is obvious that to make the rural eye camps more
scientific and productive in preventing blindness they should not have very large
number of patients, the place should neither be a big city nor a very remote village;
at least a month prior planning should be done to work out the details and a social
worker may be added to the surgical team for publicity and propaganda work.
12
Prof. S.S. Grewal addressing the delegates
Prof. Madan Mohan reading his Paper
Dr. N.K, Bhatnagar giving his after dinner speech
PGI Pattern Eye Relief Camps
(Prof. I. S. Jain PGI.’Chandigarh)
Medical Institutions, private practitioners as well as unqualified people conduct
eye relief camps in our country.
Where as the first two achieve good success rate,
the last invariably add to the misery of people by causing complications.
The camps conducted
by the
qualified people though undertaken under
scientific care are still conducted to a set pattern by usually a single surgeon some times
assisted by relatively quite junior people, mostly by para-clinical staff.
follow up of patients is insignificant or none at all.
Also the
We at PGI have tried to fill in these lacunae and present a pattern which can
reasonably be adopted by all.
We are conducting these camps without having any
separate unit for mobile eye care.
We also keep complete day to day record of the
operated patients and follow these patients upto six weeks after surgery.
Thus we
are in a position to give the exact rate of success of eye camp as we also refract all the
operated cases at the end of six weeks and some of them who can afford glasses enjoy
the luxury of seeing quite well by the correct glasses rather than by the stock number
of 4-1 OD. sph. lens supplied free.
As the people coming to eye relief camps are quite poor and for most of them
it is a last hope of getting vision or never hence we are particular to send one senior
faculty member to these camps (Professor, Associate Professor, Assistant Professor
and Lecturer).
They are assisted by junior eye surgeons who have already done
their MS and by two or three third year residents (who have put in 3 years in
Ophthalmology). This helps manifold in the sense that by presence of a senior
member confidence of
people
is
increased and the
senior member
is exposed to reality and magnitude of problem in rural area. Side by side
younger people who would be on their own in short time are trained both in
community ophthalmology as well as clinical.
13
Now coming to the Eye camp proper we try to conduct surgery there in the
same way as we do at our Institute.
After preliminaries i.c. date of camp, publicity and support of some local body
has been obtained, a preliminary team consisting of a senior faculty member, junior
surgeon, refractionist and rehabilitation officer visit the area. Proper site for the
conduction of camp is .selected depending on local availability of space, (school
building, sarai etc.). A room which is relatively airy and clean is selected for
operation. This room is washed and scrubbed by carbolic acid ; in some cases white
washing of walls, if possible, is done. Arrangements for the stay of operated
cases are also made and other necessaties like water, food and toilet facilities for
patients.
On the actual day of the camp, the senior faculty member, junior surgeon
and two or more third year residents as well as refractionist and other theatre staff
reach the site. OPD is conducted for two days before surgery. Cases for operations
are admitted. In these cases, where needed, tonometry is done as well as urine
examination and B. P. are checked and compounder is instructed to instil antibiotic
drops (chlormycetin) every 2 hours or so.
Rest of the cases in OPD are treated for varying ailments, refraction where
needed is done. People who need institutional therapy are directed to visit the same.
Cases needing entropion and other surgeries are given specific dates. Record of all
cases is kept with positive clinical feature and diagnosis.
From the third day onwards operations are conducted and they go on for an
average period of three days. Premedication of 50 mg. pethedine and 25 mg.
phenargan is used in all cases of intraocular surgery. Two or three tables are run
at a time. Anaesthesia (facial and retrobulbar) is given. Two or three sets of
instruments sterilised in a sterlizer are available all the time. Sterlization is done
under the care of a senior technician well versed with it. After giving lid and superior
rectus sutures a conjunctival flap is made in all cases. Three 7/0 black silk sutures
are given at limbus in a gutter made by blade knife from 3—9’0 clock position.
Anterior chamber is opened by keratome and section completed by corneal scissors.
Peripheral or complete iridectomy as indicated is done. Lens extraction is done by
forceps, tumbling method or in cases where indicated by extracapsular extraction.
14
After repositing iris, sutures are tied and conjunctival flap reposited back. Ltd and
rectus sutures are removed. S/C injection of streptopencillin is given. Pad and
bandage to both eyes is given for 24 hours and patient is transported in a stretcher
from the theatre. Surgeons, assistants and compounders all use autoclaved gowns,
mask and cap during the surgery. These as well as the dressings are autoclaved at
our Institute and taken to site and replaced at intervals in order to have no shortage.
Stretcher bearers are also made to use masks and caps. In the post operative period,
first dressing is always done by the senior surgeon. So he stays one day more than
the last day of surgery. On the rest of the days dressing is done by the junior
surgeon who stays till the last day of the camp. Record in files is entered of all
cases of operative and post operative progress. Camp is closed usually from 5-7
days after last day of surgery.
On the day of discharge after giving local medicines to people they are given
a date for follow up usually after 2 weeks of discharge. On this day, junior
surgeon assisted by 3rd year resident go to the site and remove sutures
and also examine the cases.
Again patients are
called after three
weeks i. e. 6 weeks after surgery and examined by the junior surgeon. On
this day refraction is conducted. Observations of these two visits are recorded.
Thus overall results of the camp are available.
Contrary to the belief of many nearly 100% of patients turn up for follow up.
By adchering to the above pattern we have got comparable results in our
camps as in the Institute.
PGI Ophthalmic Unit has organised 45 eye relief camps in various places of
Punjab (28), Haryana (8) UP (7) and J & K (2) since 1 968 to April, 1979. In the
camps 46 thousand four hundred and ten patients were examined and treated. In
total 6203 operations were performed.
15
The Role of Scientifically Conducted Eye Camps in
Prevention & Treatment of Curative Blind in India
(Dr. R. Daniel, Dr. S.K. Chopra, Dr. A. Chatterjee,
C.M.C. & Hospital, Ludhiana.
It is quite alarming to know the present situation in our country where
according the N. S. P. B. report there is 45 million visually handicapped and 9
million blind population. And it is more so when we realise, that more than 70%
of this blindness can be prevented or cured, indicating a low degree of public health
care, widespread ignorance and serious inadequacy of Ophthalmic facilities.
In this modern age every medical service instituted should be scientific, and
eye service is no exception to this. We are glad that today we are talking about
scientifically conducted eye camps and not mere “Eye Camps”, because there is vast
difference in these two services. There are thousands of eye camps held every year
all over the country, but how many of them are really scientific ? The role of
scientifically conducted eye camps in the prevention and treatment of curable blind
in our country is indisputable, where 80% of the population resides in the villages,
and many of them are deprived of basic medical and Ophthalmic care.
The term “Eye Camp” many a times carries the stigma of poor service and
quackery, of which many untrained personnels take the advantage of sporadic
activities for their personal gains Some surgeons hailed in newspapers reports as
healing benefactors leave behind a trail of poorly cut Corneas, adherant leucomata
and distorted central parts of Cornea turning many curable blind into incurable.
The possible factors which have lead to the above state in our country are
16
1.
Lack of general Ophthalmic care due to the paucity and imbalance in the
distribution of Ophthalmic personnels i. e. in the urban and rural areas,
resulting in lack of Ophthalmic services at the rural level, where most of
out population resides.
2.
Inaccessibility of various parts of the country.
3.
Quackery and malpractices by inadequately trained medical personnel.
4.
Lack of finance and general economic development.
If a Mobile eye service visits 25—30 stations in a year, it serves a great role
in this cause of prevention and treatment of curable blind in our country. Realizing
the need of such a service the N. S. P. B. has already launched a nationwide project to
fight against this calamity. The role of voluntary organisations in this national endeavor
is a vital one. Institutions like ours who are concerned mainly with training of
personnel and providing such services can play a very significant role in complementing
the efforts of our Government. We feel that the most effective way to do this is
to reach the masses and render this service in their own environment. Realizing the
need of such a service our institution started the Mobile Eye Services in 1958 under
the able and dynamic leadership of Dr. Victor C. Rambo, who is the pioneer of the
scientifically conducted eye camps in India. He had the foresight to anticipate the
MOBILE EYE SERVICES C. M. C. HOSPITAL, LUDHIANA.
GENERAL STATISTICS 1970—1978
Year
No. of
Sites
Out Pts.
Clinic
Surgery
Cat.
Surgery
Refraction
1970
11
11045
1395
854
2450
1622
1971
12
11034
1550
944
2176
1326
1972
12
10700
1833
854
2786
1665
1973
13
12666
1569
1007
1608
1238
1974
14
13528
1631
987
3178
1785
1975
18
15775
2100
1436
4207
1763
Glasses
Given
1976
20
16213
2251
1720
1977
21
18961
2049
1445
4840
9041
2047
2011
1978
34
22990
2825
1895
8624
2646
TOTAL 155
1,32912
17,203
11,142
38,910
16,103
These sites are situated in the states of Punjab, Haryana, Himachal and Jammu
and Kashmir.
17
future problems and needs of our general population, and the right approach to
solve them effectively. Thus the Mobile Eye Services became a permanent feature
and extension of the Eye Department of our Institution. It is serving throughout
the year in the rural areas of Punjab, Haryana, Himachal & Jammu and Kashmir. To
make our Mobile Eye Services effective, meaningful, comprehensive and complementary
to our national efforts we work with following aims and objectives, which are mainly,
Service and Teaching.
1.
2.
It is an extension of the Eye Department of the Medical College Hospital
to the community It maintains its Medical College Eye Department
standard where trained personnel, equipment and services are concerned.
It aims at providing total Ophthalmic care to the Community in the rural
areas in their own enviromment. Ophthalmology is such a speciality where
it-is possible to do so.
3.
It provides guidance and referral services for the difficult eye cases to the
base hospital.
4.
Ii exposes the junior dectors undergoing ophthalmic training to the village
situation. They are able to see the different ocular morbidities in their true
perspective, thereby realizing the need of such services in the country.
5.
Undergraduate medical students get experience of locally prevalent eye
diseases in its rural situation, where 80% of our population resides.
6.
It provides ample opportunity to educate the rural population about minor
eye ailments with the help of charts, slides and talks.
7.
Ophthalmic screening of school children wherever possible helps to detect
a case at an early stage, because nearly 40% of our total population is below
the age of 15 years, i. e. school going age.
STATISTICS
At present unfortunately there is no definite criteria, whereby an eye camp
may be labelled as scientific or unscientific. A surgeon conducting an eye camp may
claim that whatever he is doing to the best of his ability and knowledge under the
18
circumstances is scientific, and no one can dispute it unless we have certain standard
to call a camp scientific. The usual term “Eye Camp” gives an idea that it is only
surgically oriented, where a surgeon screens certain number of surgical eases, and
operates upon them in one day under whatever facilities are provided to him, The
post-operative care is left in the hands of a paramedical personnel, without any
facilities for follow-up services for the operated patients. The term scientifically
conducted eye camp is quite different, and according to our understanding probably
means, that it is an extension services of a base hospital, rendering comprehensive
eye care, consisting of thorough eye examination of cases including slit lamp examina
tion where ever indicated, giving medical and surgical treatment no different from
the base eye hospital, refraction, screening of school children where ever possible, and
arranging screening programmes like Glaucoma from time to time. Tt is a fully equipped
eye unit to render services in the rural areas just like a hospital, and aims at providing
mordern scientific services in the patients own environments.
With a well designed, and carefully executed approach blindness can be
considerably reduced in India by curative efforts. Nevertheless eye camps conducted
with the best of intentions, where motivation is service, and no publicity can affect
the situation adversely, if diagnostic skill fails, rules of sterility in surgery are not
adhered to, and postoperative care is inadequate. Let me emphasise here that we
arc not trying to standardize surgical techniques in Ophthalmology, we are suggesting
a workable standard of mobile eye units in rural India. There is certainly room for
variations to meet the local conditions in different areas, and one should adjust
according to the situation and make the best use of them keeping at the same time
the scientific standard of the service.
We suggest that once we attain the suggested criteria and the standard for a
scientific eye camp, we should call it“Mobilc Eye Services”or “Mobile Eye Hospital”,
rather than “Eye Camp”, which as the stigma of the eye camps of the past.
“Eye Camps” could possibly
be registered under the Health”
Ministry, or banned in principle, as in certain states, but licenced on individual
basis. One of the conditions could be, that a detailed report be submitted not of
the number of operations performed, but of the quantum of visual restoration
achieved.
19
A scientifically oriented mobile eye service should be a permanant feature of
every teaching institution and Eye Department of a district level hospital. It should
be able to render round the year services in the surrounding rural areas. To be
meaningful and complementary to the efforts of our Government we should try to
give comprehensive eye care in these mobile units. In a mobile eye unit comprehensive
eye care is desirable, but may not be practical everywhere to start with, because
of various problams like finance, lack of trained personnels, conveyance and time.
But these obstacles can always be overcome by personal interest and efforts.
India is a multi-racial, multi-cultural, multi-lingual nation. Any technique
utilised will, of necessity, be a multipronged approach, for the problem of prevention
of blindness is too wide to permit any single approach. Basically the problem can
be tackled under two main routes preferably instituted together, (a) community
development and education, the preventive part of the scheme, and (b) Mobile Eye
Services, the therapeutic part.
It is very heartening and encouraging that our Government has already taken
very definite steps towards the present day eye problems in the Country, and has
embarked upon this nationwide project, and is ready to help in our efforts. We should
realize that the task is herculean. The fight against blindness is not a fight for the
Government or Opthalmologists alone. It is a challange to the nation’s activities,
and is a problem for which a functional answer can only be given by united efforts of
people of all status of our society to efface this blemish from our land, and lessen the
socio-economic burden of the nation.
20
ROLE OF SCIENTIFICALLY CONDUCTED RURAL EYE CAMPS
By Dr K. Lail New De'hi
INTROUCTION
Health care of the people in our country mostly remained in the domain of
voluntary action in the past. This was mainly due to the indifference of the alien
rule. Eyc-carc was one of the major activities for individual philanthropists and
community organisations committed to welfare of the people.
CAMP
APPROACH
The camp approach for rendering eye-care to the people at their door-steps
dates back to early part of this century. The activity of organising eye camps for
cataract extraction was initiated by Late Dr. Mathura Das of Moea in Punjab.
Among others who pioneered in the field was Dr. Har Bhajan Singh of Gujra (Punjab)
and some others from different parts of the country. Finding it a satisfying and
rewarding activity people without formal education in modern medicine picked up
the operative skill by assisting Surgeons thus initiating entry of unqualified people
into the camp activity. This eventually attracted many others of such background
to jump into the field making it an era mostly for the un-qualified Surgeons to
exploit the philanthropists and arrange eye camqs where publicity, cheap popularity
and quantity was preferred to quality.
SCIENTIFIC CONDUCTION OF THE CAMP THE FIRST CASUALTY
The cataract camps so organised lacked in many respects due to limited
resources of the organisers and unlimited demands by the public. The first causuality
in these camps was lack of scientific capproach.
The success of operations remained more or less limited to restoring the
vision that may enable the beneficiary to count fingers from a reasonable distance.
Still a greater tragedy was apathy on part of specialists at the Medical Colleges who
neither discouraged them nor diluted their efforts by conducting scientific camps as
an alternative, May be they were too busy in their teaching & private practice to
get involved in community ophthalmology. During the past decade however, some
medical colleges have started conducting eye camps primarily to provide eye care
services and train their post gradute students in the art of field service. Having
personal first hand knowledge of one of these, I have no reason to believe that
they are not conducted scientifically. However, we cannot ignore the fact that
people today, who arc aware of their rights, expect much more as their right rather
than mercy. As such, rational, effective and scientific services alone should be
welcomed by the people.
NATIONAL PROGRAMME
Government of India has launched a gigantic programme for prevention of
visual impairment and control of Blindness. The Programme envisages establishment
of permanent eye-care services within 20 years at peripheral, intermediate and central
sector with availability of graded expertise at different levels. And, until these
services are fully established, there is a provision for deployment of 80 mobile units
@ one per 5 adjoining districts.
The services so being developed are however inadequate and the voluntary
organisations have their role to play to supplement Government efforts. Cognizant
of this fact, Central Govt, provides incentives to recognised voluntary organisations
to enable them to expand their eye-relief measures and improve the quality of camps.
Suitable guidelines have also been issued to conduct scientific and comprehensive
eye care camps.
Modern concept of eye-care camp in rural areas :
I
1.
I
Organisational aspects.
II
Surgical aspects.
ORGANISATIONAL ASPECT
Span of activities :
Ideal eye-care camp has scope wider than to serve the cataract patients alette.
The camps in addition to surgical services for indoor patients can take up eye-cheekup and vision testing through O. P. D. Survey ; school eye health, health education
and rehabilitation activities. Then alone the broad spectrum of preventable blindness
will be covered.
22
2.
Follow up
Hit and run method of earlier camps left little scope to see what had ultimately
happened to the persons operated upon. This had resulted in false sense of service
on the part of organisers and frustration on the part of many who were served.
Duration of the camp should, therefore, be eight days after the last operation.
And in addition proper follow-up must be ensured with the local health set up to
offer proper post-operative care.
The scientific aspects of eye surgery in camps should broadly include the
following.
If
SURGICAL
1.
Operation Theatre
2.
ASPECTS
(a)
Proper selection of operation room to prevent flies, dust and glare.
clean pucca room may be preferred.
(b)
Regular disinfection of the room after every operation session.
(c)
Least traffic in the operation theatre.
A
Preparation of patients
*
Proper pre-operative investigations to exclude local eye infection, raised
intraocular pressure, diabetes mellitus and systemic hypertension.
3-
*
Irrigation of conjunctival sac.
*
Face of the patient to be covered with sterile linen.
Operational procedure :—
a)
Operations by qualified surgeons.
b)
Wearing of sterile gown and masks by all those attending to operation.
c)
Applying corneo-scleral sutures in all cases of cataract surgery.
23
d)
Aseptic preparation or autoclaving of all drugs used for instillation into
the eyes.
e)
Proper sterilization of surgical instruments.
f)
Autoclaving of theatre linen and dressings.
g)
First post operative dressing by the surgeon himself or his experienced
colleague.
h)
Following daily dressings by qualified ophthalmologist and
i)
Proper attention to untoward complication during post operational period.
Results of such camps may, in the first instance not seem encouraging in terms
of quantity, but in the long run there will be less number of pan-ophthalmitis, less
number of post operative complications and less number of man made blind.
Such scientifically conducted camps will go a long way in improving the image
of eye care camp.
My thanks are due to Mr. H. T. Kansara and Mr. Thapar for their assistance.
24
Role of teachers & parents in Prevention & Detection of eye diseases.
(Prof. S. S. Grewal DMC & Hospital Ludhiana)
The human eye is a wonderful instrument, so marvellously efficient as to be
almost unbelievable but like so many other parts of human body, it often becomes
impaired resulting in any one of a number of conditions which, if neglected, may lead
to blindness. Blindness is one of the major health problems in India. The life of a
blind is a saga of misery and proverty, not so much because of loss of sight but mostly
because of psychological trauma due to desertion of relatives and friends. He is
lonely figure in his own darkened world and he is a constant burden on society. It
is estimated that there are about 9 million blind in the country and about 45 million
people are visually handicapped. Rehabilitation of the blind is a mammoth task but
we should try to undertake a lesser mammoth task of prevention i. e. the prevention
of blindness which is more practical and which can be achieved without too much
help from the Govt. It is here that social organisations can help us.
RURAL CHILDREN :-This is an international year of the child so we decided
to do something for the school children of rural areas, which constitutes 80% of the
future generation of India.
We have been experimenting for the last 4 months as to find out how we can
be helpful in the prevention & cure of preventable blindness in school children of
rural areas. For th is purpose a voluntary organisation, Sri Gurdev Dharm Arth
Naiter Hospital Society has supplied us with a fully equipped ophthalmic van in
which we have facilities for refraction and slit lamp examination. We have selected
one central village, Narangwal which is the base head quarter and we want to
survey the ocular health of all the school children within the radius of 5 miles.
Our team consisting of one doctor and one intern examines 50 to 100 school
children in the forenoon. So far we have surveyed_ over 3000 children in which the
incidence of bilateral blindness was nil and unilateral blindness was 0.34% as shown
in table No. 1
“T ,B,“k
Ba^'ore-560034
India
CELL
25
TABLE I
INCIDENCE OF BLINDESS
No. of Cases Examined
3231
No. of bilateral blindness
Nill
No. of unilateral blindness
11 (0,34%)
The main causes of blindness in these children were congenital anomalies, high
myopia, phthisis bulbi & post traumatic enucleated eyes as shown in table II.
TABLE II
CAUSES OF BLINDESS
NO. OF
% OF
CASES BLINDNESS
36.36
2*+2
27.22
3
18.18
2
2
18.18
DISEASES
Congenital anomalies
High myopia *
Phthis bulbi
Enucleated eyes
(Post traumatic)
* Curable blindness
Out of these 36.36% cases of conigential anomalies and 27.22% cases of high
myopia were of curable blindness.
The incidence of various eye diseases in the school childten is shown in table No. Ill
TABIE
III
VARIOUS EYE DISEASES IN 3231 SCHOOL CHILDREN
DISEASE
No. Of Cases
Percentage
395
131
84
51
29
76
10.94
4.08
2.60
1.61
0.86
2.35
766
22. 4%
Trachoma *
Conjunctivitis
Refractive Error
Blepharitis
Squint
Miscellaneous
Total
*
26
Incidence increased
with
age
9.8-
15.04
You will notice from this table that the incidence of trachoma has markedly
decreased. It is due to better hygne, clean water supply in these villages. All the
villages in this area have Pacca roads leading to them and people are mostly educated
as you can see from the number of schools in this area and they are health conscious.
You will notice that we did not find any case of xerophthalmia, so diseases
due to lack of viteamin A are not a problem in Punjab. We rarely see a case of
keratomalacia in the local population and over 95% of the cases of this disease are
found in the imported labour from Bihar & East U. P. ete.
As you see from table HI that 2.60% of children were having refractive error
and 90% of them were without glasses. Myopia, as you know, changes the whole
personality of the child and two children had vision less than 6/60 and were not
wearing glasses and this comes under the category of blind. That is another field
where the school teachers can help us. We intend supplying all these schools with
vision charts and teachers will inform us about any child having vision less than 6/9.
Blepharitis as you see is quite high amongst school children. It is again due
to lack of cleanliness and it is here we are going to lay strces on the parents and
teachers.
TABLE IV
SQUINT
3231
Total Population Examined
Children having squint
28 (0,86%).
Uniocular /
Alternating
5-8 Yrs.
8-12 Yrs.
12-15 Yrs.
Uniocular
Alternating
0.23%
0.23%
0.60%
0.79%
0.16%
0.46%
Total
0.46%
1.39%
0.62%
Amblyopia in uniocular squint=5 cases.
27
As you see from table IV that squint is another field where parents have to be
educated. They do not expect children to wear spectacles or submit to surgery.
They think glasses or surgery are meant for old people only.
At the time of examination the school teachers are working with the team and
they are taught as to how to take the vision (Slide 12) and taught the basic hygiene
of the eye i.e. cleanliness of hands, face, eyes with soap & separate towels, avoidance
of playing in dust & sending a child with red eye home till condition clears up. Any
child with a diseased eye is also shown to them. Any child needing treatment is
asked to bring his/her parents to school next day and the parents are told about the
disease in the simple rural language. They are advised to get the treatment. If any
medication is required the parents are told how to use the medicines and if any
surgery is required the child is sent to the department of Ophthalmology of our
college and the child is again followed up by this mobile unit.
Our experience shows that parents & teachers are very co-operative with us
and they tell us that this is the first time any organisation has come to them just to
look after the health of the eyes of their children. They only knew about eye camps
which were meant for old people only. Our aim is to check up children with the
diseases mentioned above at least once a year and survey of the rest of the children
hand in hand. Our goal is to completely eradicate the eye diseases in children within
5 miles radius of this village. Certainly blindness cannot be prevented but we are
endeavouring at least to prevent the preventable blindness like early detection of eye
diseases and their cure so that the children of this area will be future healthy citizens
of this country.
So far we haven’t met with any resistance from the parents or the children
though when we started the survey we examined the junior classes first and the
children were afraid to come near us and co-operate with us. Later on we started
examining the senior classes first and junior children got confidence from the senior
children and easily submitted to the examination. We have not yet surveyed the
preschool going children but any child who has defect like refractive error or squint,
his parents are encouraged to bring the younger siblings for examination.
So the notion by some peopie that school teachers and parents cannot be used
for voluntary work is wrong. It is we who have to involve ourselves with the parents
and teachers. You can’t just leave it to them by sending a few hundreds of Terram28
r
ycin eye ointment tubes for use on children. This school programme, I am sure will
help in the restoration of better eye-sight of our future generations. The task is
gigantic and we need more doctors and vans for this work. This is our pilot project
and we have been doing this work for the last 4 months and after a year we will be
able to come to some conclusion as to how much staff and equipments we need. I
feel it is the initial survey which will be difficult and once we know about the defective
eye-sight of the children, we can have a yearly foliow ,up of these children. I think
after seeing our results, more voluntary organisations like Sri Gurdev Dharm Arth
Naiter Hospital Society will come to our aid.
29
Role of Teachers & Parents in Prevention & Detection of eye Diseaser
Dr. T. K. Chaku C. M. C. Ludhiaha
Eyes comprise sense organs par-excellence. Their versatility in function is
unmatched by any other part of the body. They are responsible for feeding us with
eighty to ninety per cent of total information that we gather from all our sense
organs. Eyes are highly sensitive to any insult however trivial that may be and
in attention to the elimination of the offending cause leads to the ultimate fateful
result of visual failure varying from partial to total loss. Fortunately most of the
blindness prevalent is preventable and curable provided corrective measures are
instituted in time and in the initial stage of disease process. Delay and improper
handling meets the same unfortunate end as it would have been in case the ailment
was left totally unattended.
Therefore, we derive that ignorance to perceive the gravity of the ocular disor
der together with negligence, delay & inadequate care are the root causes of breeding
visually handicapped people in astronomical figures. Further introspection into the
problem leads us to comprehend that all these maladies in the society are on account
of total deprivement of health education (I mean ocular health in particular) among
masses both urban and rural. The rural masses though comprising eighty per cent
of the population are under privileged, therefore, bear the major brunt of this
distressful situation.
This envisages upon us to mount a massive ocular health education drive
throughout the country. To make a plea for it on this forum is easy but to work out
the modalities to put the idea into practice needs a sacrificial service from the society
in general. It demands active involvement of all those who constitute a society but
there are limitations to such a course, like if responsibility is given to every one in
the same measure then it loses its sanctity and bite. Therefore, the task of educating
the masses about the ocular health has to be assigned to a cross section of the society.
To salvage the humanity in general and our country in particular from the
curse of blindness, voluntary organisations have a tremendous role to play. A
country like ours cannot cope up with a staggering budget of millions of rupees to do
this stupendous and astounding task single handed. Govt, agencies cannot be expected
to cater to this gigantic problem with so little resources at hand. Therefore, voluntary
30
institutions have to gird their loins and take up the challenge to every corner of the
country.
In this respect I feel that teachers and parents constitute the answer to our
need of mass ocular health education programme that will ensure prevention and
detection of ocular morbidity and culminate in the maintenance of optimal ocular
health.
The task force of parents and teachers is present wherever the human race is
stationed. They form a part of the society for which they have to work. They are
aware of the orthodox and superstitious background of the society of which they
themselves constitute an integral part.
This cross
section
of
the
society
if guided properly about the detection
and
prevention
of
ocular disorders
can
bring about transmutation to
the
fixed,
false
and dogmatic notions prevalent in the community which is responsible for
poor or total lack of ocular health. I believe teachers and parents can be our best
bet for revolutionising the response of the masses to ocular health care. This combi
nation of teachers and parents should be given instructions on a war footing because
the problem is footing colossal and there is no time to waste now. These sentivels
of eye care must further propagate and disseminate this knowledge to the community
around. The message as it will percolate to the grass root level is bound to pay the
rich dividends.
In case of teachers it means imparting the basic components of eye care to the
children as a part of the educational curriculum. Young children hold their teachers
in high esteem and their pronouncements carry a high degree of credibility. Apart
from their credibility among children teacher in a rural area is considered a source
of wisdom though in an urban area this may not be true.
The teachers that I am talking about are the ones in the primary schools. The
teachers at this level have mass contact on account of greater number of children
attending the schools in primary classes after which majority dropout on
account of socioeconomic compulsions. An advantage of utilising the services of
these teachers is their local background.
This makes the local popul
ation receptive to the new idea without arousing any suspicions.
The
whole thing becomes easy to assimilate in the local colloquic ideas coming from
people being implanted from outside are always fraught with intrigue and ulterior
motives.
31
Therefore, wisdom demands that the perception of ocular health which encom
passes prevention and detection of ocular disease should spring from within the
community concerned rather than being forced from outside.
Parents apart from their own interests have the interest of their children at
stake and therefore, will exhibit considerable zeal and gusto in carrying out the mass
ocular health educaiion programme. Thus teachers and parents can act and work
complementary to each other.
Now the big question that hangs fire is who is going to impart the basic preliminary
knowledge about ocular health to teachers and parents. Here we can make use of the
basic health worker who is already carrying out other health programmes. The basic
health worker remains in close liason with the people of the area that he covers and
therefore, can deliver the essentials of ocular health to people at their door step,
Following are some of the recommendations that the baic health worker may pass on
to the parents and teachers. Here I am giving a very broad out line as elaborate
account is beyond the scope of present paper.
1.
Stress the importance of eyes in the general well being of the individual.
2.
Avoid treating eye ailments by home remedies or by quacks which does
more harm than good.
3.
Create an awareness about the symptoms such common but crippling eye
disorders like trachoma cataract, glaucoma and corneal ulcerations that
take a very heavy toll of the eyes. It should be stressed in no uncertain
uncertain terms that medical care by qualified ophthalmologists should
be sought when symptoms pertaining to the above mentioned diseases
appear.
4.
Eyes to be regarded as very delicate organs that keep on the legacy of the
insult to scornful results.
I am sanguin that if the essentials of eye care involving prevention and
easy detection of eye disorders are brought to the awareness of general public through
the agency of teachers and parents there is no reason why blindness if not completely
banished can be effectively brought down to a trickle.
Another asspect of the problem is that apart from the lack of facilities to
tackle all the patients who are curable blind, the major problem is non-utilisation
32
of the present facilities to the optimum level by the people on account of total
ignorance.
Unless and until this depressing ignorance about the ocular health is dispelled
from every hook and corner of our country in particular and world in gensral
millions will continue to go blind even if facilities for treatment are available at their
arms reach.
Blindness to an individual is not only a physical and a mental handicap for
the patient but is crippling to the development of his personality. The individuals
who support him also remain in a state of emotional agony and distress. The blind
person in addition constitutes an economic burden to the unit concerned and a loss
to the country.
The crux and the essence of the entire problem as I perceive it is the complete
lack of ocular health education among masses. The day our masses get enlightened
about the ocular health, the goal is not far off when blindness can be a rare commo
dity. To conceive of such a mass education programme the modus operandi have
to be the teacher and parent combination that form greater part of the society.
33
Mobilisation of Voluntary Organisations in Prevention
and treatment of Curable Blirdness
(Dr. Madan Mohan Dr. Rajendra Prasad A. I. I. M. S. New Delhi.)
There is no death of voluntary organisations in our country. Some of them
are big, others are small organisations engaged in numerous multifarious activities.
Some organisations already have a very active involvement in sight conservation
programme such as Lions International and Rotary International. These organisations
can be further activised provided with technical leadership and information to
intensify their work and to start newer projects concerned with prevention and
treatment of blindness. There are, however, many other social and voluntary organisat
ions who are not engaged in any continuing programme for the prevention of
blindness. Traditionally they have been involved in religious or educational or other
social work. Thus we may divide the voluntary organisations into
1,
Which are traditionally working in the field of prevention of blindness and
2.
Non-traditional voluntary organisations which need to be mobilised for
adopting prevention of blindness as one of their objectives.
Today I would like to share my views on the methodology that can be adopted to
34
(i)
How to activise the traditionally active organisations to intensify the work
of prevention of blindness.
(ii)
How to induct, motivate the non-traditional organisations to take up such
activities on their charter of objectives, but in my opinion It can be
achieved by getting into these organisations and gradually working within
them bring a change and motivate them to take up the prevention of
blindness work. It will be necessary also to delineate the role of the
organisation
as
also
of the
individual
members in the
programme. Let each organisation earmark the area of its activities and
let each member of such organisation adopt ten families for ocular
health care.
The National Society for the Prevention of Blindness is primarily and solely
concerned with the prevention & control of blindness. It should organise its activities
and should try to bring about an understanding, co-operation and coordination of
activities of various other voluntary organisations engaged in ocular health care and
prevention of blindness.The Society,! understand, has under the leadership of President
D . Sushila Nayar&Vice President, Dr. L.P. Agarwal made tremendous advancement &
now has a good financial base and a large membership to be viable. The Society should
have a planning and evaluation cell for continuous monitoring of our activities and
should conduct research for further improvement in our efforts and analyse the factors
as to why after twenty years of our existence we have failed to achieve greater
involvement of other voluntary agencies in the prevention of blindness work.
Inspite of our achievements, you would agree with me we have made only a
small bent in tackling of the problem. The Society still has not been able to reflect
a national image but still is dominated on its executive and governing bodies by the
Ophthalmologists and has not been able to induct social workers from other walks
of life. Even in the meeting today I do not find many representatives of the voluntary
organisations who are traditionally committed to sight conservation programme. I
would suggest that we must have a minimum of 50% representation on our various
executive and governing councils of members from different social organisations and
other walks of life
We should also try to raise our funds by direct donations and contributions
from the community apart from life membership and annual subscriptions. We
should try to reduce our dependence on the international agencies.
35
ROLE OF TRADE UNIONS AND EMPLOYERS IN PREVENTION
THROUGH HEALTH EDUCATION
(Dr. R.N. Sud, D.M.C. & Hospital, Ludhiana)
Accidents in industry are becoming more and more common because of fast
industrialisation of our country. Every year 30 lakh man—days are lost through
accidents in industry.
What does a worker lose, as a result of accident ? He loses his wages. There
is a suffering for him and his dependents. And what does the industry lose ? The
industry loses in the form of compensation, has to provide medical care to the injured.
There is decreased production and damage to the machinery and goods. What is
nation’s loss ? Nation loses in terms of production.
Ocular injuries form 3—5% of all accident occupational injuries. No industry
is entirely immune from ocular hazards, but in general they fall into following main
groups :—
(1)
MECHANICAL : In this category, engineering workers are the com
monest sufferers. The most frequent and most dangerous agents are small chips of
flying metal producing an infected abrasion or a perforating wound. CORNEAL
FOREIGN BODIES are by far the most common of all such industrial injuries. Ocu
lar injuries can also occur due to molten metal.
(2)
CHEMICAL : There is hardly any industry where some or other chemicel is not used, and their use in industry is increasing day be day. Eyes may be affected
as a result of splashing of a chemical.
(3)
RADIATION :
(a) U/V radiation : Mainly in arc weiding causes severe Keratoconjunc
tivitis (WELDER’S FLASH)
(b) High Intensity Visible Light.
Before actually going into the preventive aspect. I would like to present some
statistics of cases of ocular injuries in industry seen in Dayanand Medical College &
Hospital, Ludhiana during the past 43 years
Affection of eyes among industrial workers is a big problem and so its
36
prevention is equally a big task. The solutions to the problem lie with the manage
ment, trade unions, the social and voluntary organisation and the government, and
they all have to join hands to solve this problem. The day each realises its responsi
bilities, tangible solutions would be found out in prevention of blindness in industry.
It is amazing to know that over 95% of ocular injuries in industry are preven
table, if proper precautions are taken. About 90% of ocular injuries are caused by
foreign bodies, wouuds, burns and scalds, and by contusions and that the remaining
10% by infection, radiation, fall etc.
When a person gets injured while working, he undoubtedly, is going to get
full compensation. But that is not going to bring back his damaged or lost eyesight.
PREVENTION OF OCULAR INDUSTRIAL INJURIES :
Prevention of this type of injuries assumes a very great importance because of
the fact that 95% of them are preventable. Employers and employees probably tend
to forget that the eyes of the workman are the choicest of his working tools and deserv
ing care the most. The employers and the trade unions can do a great deal to help in
the prevention of ocular industrial injuries.
ROLE OF EMPLOYERS : It is the moral and legal responsibility of the
employers to provide protective equipment to workers, and to enforce all the safety
measures whole-heartedly; According to the majority of industrial safety researchers,
the most important factor in prevention of industrial accidents is the attitude of the
employers. If the employers exhibit a safety conscious attitude and back it up with an
active safety programme, work accidents can be reduced to a great extent.
They can help in prevention of ocular accidents in following ways :—
1.
Screen all the employees for various visual defects.
2.
Provide safety equipment and teach the employees its use.
3.
Must see to it that the safety equipment is used by the Employess.
4.
Publicity regarding safety measures in the form of lectures, films and
exhibitions at regular intervals.
5.
Display of posters or pictures showing various safety measures at various
strategic places or sections of the industry.
6;
Adequate design and painting of the workshop and the machines so that
dangerous moving machinery stands out clearly.
7.
Fitting of guards on machines from which flying particles are to be
37
expected.
8.
Incentives to employees or sections who are free of accidents.
9.
Provide adequate goggles (which arc comfortable to wear and through
which vision is easy), eye shields and face masks.
10.
Periodic check up of ocular fitness and timely treatment of any defect
found.
11.
EducatingThe employers in the use of first aid. This is important, more
so in the case of employees in chemical industry, so that no time is lost in
waiting for the doctor to come and irrigate the eye.
12.
Provide first aid post for giving first aid treatment before patient can be
shifted to a hospital.
13.
Provide facilities for treatment of miner injuries e.g. removal of foreign
bodies on conjunctiva or cornea.
14.
Setting up of safety committees comprising of representatives of employees
employer. Government and industrial safety experts, to go in detail into
the causes of each accident and recommend necessary preventive measures
to avoid any future recurrence.
ROLE OF TRADE UNIONS :
We must realise that the employers may not be able to achieve much without
the active support and cooperation of labourers with increasing trade unionism, and
their hold on labour, trade unions can help a lot in prevention of ocular hazards in
the industry.
They can :—
1.
Impress upon the employers to provide all safety devices to the workers.
2.
Convince each worker to use various safety devices for his own good.
3. Arrange periodic lectures, films or exhibitions to educate the workers in
prevention of accidents.
4.
5.
religiously.
Teach the employees in various first aid methods.
Must see to it that each worker uses various safety devices regularly and
6.
Along with representatives of the management and Government, go into
38
detail of each accident and suggest means to prevent its recurredce.
7. Instruct the workers to report to the factory doctor, whenever there is an
eye complaint and have treatment.
SUMMARY : With fast industrialisation of our country, ocular accidents
are increasing in number. Prevention of these accidents assumes a special significance
because of the fact that over 95% of them are preventable.
Statistics of industrial Ocular injuries seen during the past 4i years in
Ophthalmology deptt. of Dayanand Medical College & Hospital, Ludhiana, are men
tioned. Role of employers and trade unions in the prevention of industrial ocular
injuries is stressed and some suggestions for prevention are made.
(Illustrated with black and white slides)
□
39
ROLE OF ROTARY CLUBS IN PREVENTION OF BLINDNESS
AND VISUAL IMPAIRMENT
(Dr. N.K. Bhatnager Allahabad)
“One of the basic human rights is the right to see. We have 2
ensure that no citizen goes bli nd needlessly, or being blind does not
remain so, if by reasonable deployment of skill and resources, his
sight can be prevented from deteriorating, or if already lost, can be
restored.
—National policy pronounced by the central council
of health at its meeting held in April; 1975.”
THE PROBLEM
—
Nine million are blind, 45 million are visually handicapped in India.
—
Maintenance of the blind costs the nation Rupees 8100 million every year
(Rs. 75/- per person per month).
—
Loss of production (Rs. 5/- per man day) is around Rupees 10,800 million
every year.
—
Over 80 per cent of the blindness can be prevented or cured if eye-health-care
services and education on eye-health care can reach the remotest area of the
country.
—
The problem of visual impairment is not an ophthalmic problem alone but it
should be evaluated in a socio economic and cultural complex.
—
Under the National Programme launched by the Government of India. Eye
Camps envisaged therein are to provide comprehensive eye health care in the
community.
INTRODUCTION
Eye-Camps hither to organised by the Voluntary/Social Organisations etc.
have primarily been cataract camps. National Programme for the Prevention of Visual
Impairement and Control of Blindness envisages organisation of Eye-care camp within
the broader perspective of providing comprehensive eye-health care facilities to the
people particularly to those giving in remote rural areas where eye-care facilities are
practically non-existant.
40
OBJECTIVES OF COMPREHENSIVE EYE HEALTH CARE CAMP
(NO MORE CATARACT CAMP)
—
Provide consultation and medical and surgical treatment for the prevention and
control of eye diseases including glaucoma and cataract operations.
—
Educate people in the methods of prevention of eye diseases and proper care of
the eyes in order to ensure better and lasting eyesight.
—
Organise survey to assess the prevalence of various eye diseases and the incidence
of blindness.
—
Detect early visual defects and provide suitable glasses or low vision aids at
cost price to the persons suffering from such defects.
—
Help in the rehabilitation of the blind in their own surroundings by training the
blind in the art of daily living and mobility and give them proper and suitable
vocational training.
—
Promote community participation in eye health care.
COMMUNITY PARTICIPATION (THROUGH CO-ORDINATION COMMITTEES)
—
Planning and implementation of the programme will be guided and monitored
by committees with respesentatives from the community, voluntary organisations,
international voluntary agencies, and medical, health and other Government
agencies from the periphery to Apex levels.
—
These committees will strive to mobilise community participation in the
implementation of the programme. The functions of these committees are :
*
*
Planning of the programme.
Mobilisation of resources.
*
Fixing of priorities and implementing t ie programme.
*
Conducting concurrent evaluation of the programme.
VOLUNTARY ORGANISATIONS
These Voluntary and Social agencies aim at providing the following services :
—
Eye Health Education
—
—
—
—
Organisation of eye camps
Survey of the community for early detection of visual defects
Distribution of spectacles
Rehabilitation of visually handi-capped.
41
THE OBJECT OF ROTARY
The Object of Rotary is to encourage and foster the ideal of service as a basis
of worthy enterprise and, in particular, to encourage and foster :
FIRST—
The development of acquaintance as an opportunity for service:
SECOND— High ethical standards in business and professions: the recognition of
the worthiness of all useful occupations, and the dignifying by each
Rotarian of his occupation as an opportunity to serve society.
THIRD— The application of the ideal of service by every Rotarian to his personal,
business, and community life.
FOURTH— The advancement of international understanding, good will, and peace
through a world fellowship of business and professional men united tn
the ideal of service.Rotary came to India
...1920
Total No. of Clubs in India
...over 800
No. of Rtns. in India
...over 30000
No. of Clubs in the World
...over 18000
No. of Rtns. in the World
...Approx. 8,40,000 in 152
countries & Geographical regions.
The magnitute of the implementation of any national programme through
Rotary Clubs can be imagined by the above figures so far as the involvement of the
community is concerned.
ROTARY AND THE INTERNATIONAL YEAR OF THE CHILD
One quarter of the children in developing nations are malnourished. At any
given time, 10 million youngsters under age five suffer such severe malnutrition as to
be actually on the verge of death. The United Nations Children’s Fund (UNICEF)
estimates that 350 million children in developing regions are beyond the reach of
minimal health, nutritional, educational, and social services. And even in such
“modern” nations as the U.S.A., a National Research Council Committee reports, one
out of every six pre-school children (some 3 million) lives below the poverty line.
What is more, one third of U.S. children (more than 20 million) never get such basic
medical care as complete immunization and prompt treatment for disease.
“The first five years of life are the crucial, formative years, “says Dr,
Labouisse”. A child deprived of food and elementary health care may be hurt for
life—if he aurvives at all—and never grow into a normal, productive adult.”
ROTARY AND 3 H PROGRAMME
A wide-ranging new program called Health, Hunger, and Humanity has been
42
established by the board of directors of Rotary International to help clubs plan and
carry out bigger and better child welfare projects. The purpose of the 3-H program
is to improve health, alleviate hunger, and enhance human and social development of
people—especially children-around the world.
Specific programms will include
immunization against communicable diseases; encouragement of better methods of
food production and distribution, and projects to raise educational, social, cultural,
environmental, vocational, and spiritual levels.
ROLE OR VOLUNTARY ORGANISATION—DECADE AGO
According R.R. Doshi “we are conducting eye camps through voluntary
organization for the last 17 years in Gujarat. 15 eye specialists have joined and offered
voluntary services for 2-3 weeks every year. Five to seven places are selected in
different districts of the state where there are no eye hospitals or established eye clinics
Follow up programme is carried out for 2 months at least after the camp is over.
Exhibition of posters is kept with film show and slide demonstration for pre
vantable diseases. Lectures by eye specialists and health educator are arranged in
camp and surrounding villages.
Above programmes are conducted by seeking co-operation of social clubs at
some places who are always eager to help us for our prevention programmes. At
some places even single person comes forward and help whole eye camp unit. Teachers
retired servants and students take keen interest for such activities. So I feel that such
treasure of voluntary services should always be taped for any minor for major field
operations.
REFERENCES
1. Bulltin on National Programme for Prevention of visual impairment and
Control of Blindness India published by Ministry of Health and Family
Welfare. New Delhi dated June 15, 1978 : Pages inside cover, 4, 9, 27.
2.
3.
4.
5.
6.
7.
Bullitin on Guidelines for Organising Eye Care Camps published by
National Society for the Prevention of Blindness. India New Delhi dated
February 16, 1979 : page 6, 7.
Bllitin on The Rotarian International Magazine', September, 1978 page 5,
—do— May, 1 978, pages 36 & 37
—do— October, 1978, pages 25
—do— January, 1979, pages 19, 20 and 21.
Proceeding of the 1st Annual Conference and National Symposium on
Early Detection of Visual Defects & Its Rehabilitation Aspects held on
March 11 & 12 March, 1967, pages 65 & 66 Role of Voluntary Organi
sation in Mobile Units and Eye Camps by R.R. Dosi
43
Role of service organisation such as Lion, Rotary Club, Indian Red Cross and
Panchayat etc. in prevention of Blindness and treatment of curative blindness.
(Dr. M. Mathew, Dr. P. S. Sandhu)
It has now been estimated that there are 40 million blind people all over the
world today and 80% of them are in developing countries. Two thirds of these are
either preventable or curable blindness. The Indian Council of Medical research
reported that there are 9 million blind in India of this nearly six million are cataract
cases, which can be cured by operation. It is alarming to know that there are 45
million people in India alone who are visually handicapped. These hard and fearful
facts should cause concern to all individuals, societies, organisations and the govern
ment to formulate plans with a view to reduce the economic liability of the country
and mitigate serious social dependency of the blind population on their families and
communities.
Apart from the physical handicap whieh are the lot of blind, the emotional
trauma as a result of loss of eye sight is something which we as opthalmologists and
others who are partners in the venture of prevention of blindness should be aware of.
Though the opportunities of education and employment, do help in restoring the self
confidence and self respect in the blind, the ultimate is still far away from all mankinds
effort, i. e. to take away the years and years of darkness infront of them.
Thus it is obvious that the problem of blindness facing our country is a collosai
one, requiring urgent attention. Prevention of blindness must be given the highest
priority and receive full attention and implementation at all levels, both at the Govern
ment and well established organisations.
I am here to delibrate on the role of service organisations in the prevention
of blindness. Service as their motto, is the prime concern of the organisations like
Lion’s club. Rotary, Indian Red-cross and their active participation in curing the
blind in the past should be recorded with gratitude. However much needs yet to be
done. Therefore more voluntary organisation should be actively involved in taking
care of the backlog of cataract operations that need yet to be done in our country.
There are various other organisation both religious
44
and
otherwise
like
Aryasamaj, YMCA, YWCA, Mahavir Dal, Bharatiya Parishad, Vishal Hindu Parished
to name a few. More than these the Panchayat should have more active part to play
in the prevention of blindness and treatment of curable blindness.
In orher to achieve any target laid down, a well planned, well directed integrated
strategy should be launched. Therefore the service agancies can take part 1. In chang
ing individul’s behaviour. This can be changed only if there is change in the standards
of groups, its style of leadership, its emotional atmosphere of stratification into ehiques
and hierarchies. People in contact with rural population should be first subjected
to studies in Socio-physiological environments such as belief’s, prejudicis and atitudes
of various other lingustic groups. Local opinion should be activised because of their
credibility, quality and persuasiveness is very effective on the minds of people. Hard
core resisters should be exposed to situations of suffering and remedial treatments
and its aftereffects. These can be effectively done by service organisations, which is
really a, peoples participation.
2).
Enforcing preventive health practices, especially eye care
This can be easily done at the level of village Panchayats. Eye care programme
though lanched through Health workers in the communiiy, their work can be easily
supervised by the Panchayat, to find out any lacunae and remedy them by orienting
the higher authorities. Primary health workers and PHCS. in the villages should be
made pivots to popularise preventive practices. Primary health centres can certainly
function as clearinghouses, for information which would be carried by local opinion
service agencies. Primary Health centres can announce every season what varieties of
vegetables and fruits are cheap and locally available food which would supply vitamin
‘A’ at that particular season. This would prevent nutritional deficiencies leading to
bindness.
PHC can organise village to village eye care campaigns, identify cases and
arrange for specialists attention at their centre atleast once a week. Any hospital
would agree to this extension work gladly.
PHCS should be able to warn people against epidemics, that afflict in seasons
and prescribe preventive measure as in Red eye syndrome. Therefore it is very essential
to have close co-ordination proper linking, and integrated approach between the
PHCS, service agencies and villages/urbanised villages for popularising informations,
campaigns widely and in time. This co-ordination between voluntary agencies and
villages in the PHCS, is lacking, and should be taken up for an integrated scientific
approach to the problems of eye care and curable blindness.
45
3.
Subsidies to local costs for Prevention of Blindness.
At present the scheme for setting up mobile eye hospitals cames from the top.
It is considered that Ophthalmologist should go to villages and find out and set up
eye relief camps, or mobile eye hospitals. I personally think the voluntary agencies
should be totally engaged in the walfare of the community in villages and they should
involve the village Panchayat and block authorities in co-peration with local health
centres and get in touch with the nearest hospital to arrange for periodic eye relief
camp. The voluntary agencies should mobilise resources and finance to provide all
facilities for such camps. Hospitals and Medical Colleges are hard pressed with their
limited facilities and especially with medical personalle, authorities that also however
should be oriented to the need of community and should not refuse the personalle and
equipment to run short-term eye clinics, and eye relief camps and visiting PHC’s
periodically. Nursing personalle is always deficient in hospital itself let alone to be
taken out to eye relief camps.
Perhaps the voluntary agencies, especially Women’s wing of Youth Organisation,
inner wheel club, should be educated in getting the nurses work tidied over in camps.
In a situation such as this1 it would be well, that the service organisations and PHC’s
and Panchayat be attached to each district hospital/Medical College, so that together
they reach the masses where there is a need for treatment of curative blindness.
4.
Assessment and evaluation of programme :
The prevention of blindness and treatment of curative blindness is a continued
programme and its success, assessment and evaluation is very essential. Padchayat should
follow up eye camps. A single failure of operation and treatment would give rise to
to remours and sceptiscism in the entire village. Therefore they should keep a close
watch and any complication should be reported immediately to the Health Centre
who inturn should take expeditious action and if necessary call in the specialists to
remove the cause of complaint.
5.
Men power development.
It is feasible for every service agencies to have a strong education wing. This
can take care of pregnant women and new-born children to educate them on pregnancy,
and its demands, how to eradicate nutritional anaemia in pregnancy, how to take
care new born babies eye and how to preserve sight. They can conduct regular classes
on nutrition, education hygiene of eye. They could organise themselves to visit schools
and to check-up vision and spearate out the children neediug an ophthalmologist
and bring them to him or vice-versa, whichever is fessible in the circumstance. It is
possible for these service organisation like Lion’s, Innerwheel Club, Rotary Club, to
46
be pioneers and start new programmes. At present, they contribute in the way of
finance and the banners for their publicity and fame. What is lacking is personal
involvement in these eye relief/mobile eye hospitals camps. Many a time, from many
camps it is reported that doctors have operated cases and they are under the mercy
of a compounder or ward-orderlies, and is done under the auspicis of a service
organisation. This should be strongly discouraged.
6.
Supplise & equipment.
It is a well known fact that Government resources are not enough to meet the
supplies and requirement of all hospitals. In such circumstances it is ideal that service
organisation like Lion’s club, Rotary, and Philantheropists can donate specific equip
ment and other badly needed iteams. If there is a co-ordination between the
Government and service agencies, this problem can be easily surmounted.
Tcerefore a planning at a higher level is essential to involve the voluntary
agencies in a proper manner. This can oniy be done at the Government level to
benefit from such voluntary organisations to the maximum.
7.
Mobilisation of resources.
At a local level, volnntary donations from individual religious organisation
local government and any other local agancies like Lion’s Club, Rotary club etc. can
be mobilised.
These organisations can organise charity shows, plays and dances, and various
other ways can collect funds for the purpose of eradication of blindness. I believe
that these service organisation should be tagged to the various dispensaries, hospitals
and medicals colleges or where-ever qualified ophthalmic persoualle is available and
they alongwith the PHC and local Panchayat should be able to tackle the problem of
blindness in villages. In the urban area it is not at all necessary to hold eye camps to
treat curable blindness but the voluntary agencies can put in their mite by working
among the low-income lower resource group. So that, that the needy should be
reached to the hospital nearby for necessary treatment.
It is invariably found that people are only aware of big hospitals
and these are over crowded, where as in small hospitals where facilities and expertise
exist the ward has empty beds. This situation, exist of course in big cities, and as
such can be avoided only by educating the population and teaching them virtually by
hand. Of course this is only possible after winning their confidence. Here again
the service organisation can help to overcome the problem. Administrators and
planners should also be made aware of the social and economic benefits of the
45
programme by the service agencies and at a low cost, so that necessary guidelines can
be drawn up by them, and the government is aware of the need, and the task ahead
in the country. It is also necessary for them to visit such a camp or mobile hospital
to orient themselves with the magnitude of the problem.
Therefore while taking note of the voluntary agencies, philanthropists,
National government. Inter national and United Nations agencies as possible sources
of various forms of aid a co-ordinated attempt is necessary which is lacking at present
to channelise these aids through all the hospitals in the country uniformily tnan a
consolidated aid for few Institutions in a gigantic way. Such a co-ordinated well
planned linked action between government, and voluntary agencies would go a long way
to present blindness, and treating curable blindness.
Finally to quote Sir Wilson about blind people, they Jive in communities which are
under privileged, under served under motivated undervalued, the very communities
which are increasingly becoming the central focus of United Nation’s stratigy. They
are not just embarrassing statistics, they arc individuls not rehabilitated blind people
with jobs and status but people for whom blindness is a thing of bitterness, dragging
their families into destitution killing hope.
In justifying the co-ordinated action between governmental, and voluntary
agencies, we may have to modify the the laws and many regid rules and agree with
Sir. Wilson that justification is not just the commitment of a scientist to his scientist
to his science, a planner to his priorities, but because it is a right of human beings
to see and because no one-however poor, inarticulate, or economically ncgligiable
should remain blind, if by the exercise of a single inexpensive skill can restore his sight.
COMMUNipy
health cell
326, y /ci,,-
I Block
D“‘°‘"br>gala
an9a/ore.560034
India
ROLE OF RELIGIOUS INSTITUTIONS IN PROMOTION
OF PREVENTION AND TREATMENT OF CURATIVE
BLINDNESS IN RURAL AREAS
(Dr. N. S. Baweja, Civil Hospital, Jullundur.)
I have for a number of years been posted and later on associated with a few
places of religious importance in Punjab. These places were in rural and semirural
areas. I have held about 30 to 35 eye camps in the religious institutions of these
places (mostly Gurudwaras) and I will discuss very briefly my experience of these
places and how further these religious institutions can be utdized in the prevention
and treatment of curable blindness. Religious institutions with good building exist
in almost all big villages of Punjab.
So far in Punjab many of these institutions are providing medical and surgical
treatment for the control of eye diseases by holding camps periodically, generally
twice a year, during the eye season i. c. March/April and October/November months.
These camps are held with the help of Eye Surgeons cither from the Mobile Eye
Hospitals or Government Hospitals or from Ophthalmology Departments of Medical
Colleges and sometimes by eminent private practitioners in Ophthalmology. However,
it is the Eye Mobile Units which can and should ’utilise these institutions in fulfilling
the task set forth in the national programme for the prevention of visual impairment
and control of blindness in India.
The advantages of holding eye camps in these places in rural areas are—
(i)
Accommodation
In the villages and semi-rural areas these places have generally the only good pucca
buildings and they arc invariably the cleanest buildings available with arrangements
of fly proof wire-gauge doors etc. These places have many rooms meant for the stay of
visitors and these can be converted into good Operation Theatres and Wards with
facilities for bath-rooms and sometimes even flush-latrines.
(ii)
Free Kitchen facilities
These institutions have already got free kitchens running for their visitors and
in the eye camps they provide satisfactory free diet not only to the patients b.it also to
their attendants. They also look after the boarding of the Mobile Unit teams. This saves
all of them from lot of botheration because there are no hotels etc. in the villages.
49
Tin’s by itself is an added attraction to the patients to get themselves operated at
these camps.
(iii)
Medicines etc.
These institutions are generally sufficiently well financed so that they provide
willingly all medicines required for use in the camps.
(iv)
Free glasses
Operated cases are generally provided free Aphakic glasses by them.
In all these spheres these religious places are far better than any other institution
in the rural area such as schools, panchayat ghars and Government Rural Dispensaries.
In the development of Community Ophthalmic Service at the peripheral level
one of our other important aims is to educate people in the methods of prevention of
eye diseases and proper care of eyes in order to ensure better and lasting eye-sight.
These religious institutions are first class places for achievment of the above aims
in the rural areas. At these places gatherings take place at regular intervals such as
Amavas, Pooranmashi, Gurupurab etc. On a few occasions I have given lectures from
these platforms about care of eyes and these were well received. Eye Mobile Units
need to avail of these opportunities to educate people in the care of eye by giving
lectures, film, shows holding mini exhibitions and free distribution of literature etc.
If, at the same time, the Mobile Units set up one day visual defect detection camps at
these gatherings, they can prove very useful for the people. The organizers of the
religious institutions can, sometimes, be persuaded to subsidise and help in providing
suitable glasses at cost price or even cheaper to the patients.
Another important field where the religious institutions can play their role is
in the rehabilitation of the blind by training them in the art of daily living and provid
ing them suitable vocational training. Already quite a number of musicians and Singers
employed in the religious places are blind persons and many of them have learnt their
art in the rural areas itself. The religious institutions have inclination, resources and
accommodation available to do this type of work and with persuasion, encouragement
and guidance from the national society for prevention of blindness many of them may
become willing to run other vocational courses for the blind which can go a long way
to rehabilitate them. Already in Puujab many of the Andh-Vidyalas are being run by
the religious institutions.
In conclusion it is submitted that these religious places have a great role to play
in prevention and treatment of curable blindness in collaboration with the Mobile Eye
Units. Also they have a role to play in the establishment of Andh-Vidyalas especially
in the rural areas.
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—Omkar Ptg. Press Phone 32083
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