Community Outreach Programme
There are an estimated 45 million blind people worldwide; 12 million of them live in India. While these figures are staggering the fact that more than 80% of this blindness is needless - that is, it can be prevented or cured, makes a community approach to eye care extremely crucial.
India was the first country to launch a nation-wide programme to tackle this problem. But in spite of the best efforts of the National Programme for the Control of Blindness (NPCB) India still has the largest number of blind people in the world.
The problem of blindness particularly in developing countries is not solely a medical problem but also a social one. In our experience it is common for blind people to be neglected both by family members and their community. They are considered to be an unwanted burden. As the unfortunate saying goes " A blind person is someone who has a mouth with no hands."
Need and importance of community outreach
Since cataract which is a major cause of blindness and visual impairment is a curable disease it is important to look at all the different factors that prevent people from accessing treatment. These factors have socio-economic implications and are listed below:
- A basic lack of awareness about common eye diseases and treatment methods
- No one to accompany the blind person to the hospital (many of these people come from daily wage earning families)
- Lack of money for transportation
- Fear of surgery
Because of their lack of awareness and poverty they continue to remain needlessly blind. The social and financial hardships created by blindness gravely affect individuals, families, and the nation at large (Fig. 14.1).
Objectives of outreach program
- Since cataract is the major cause of blindness, the main objective of conducting eye camps is to identify people with cataract and provide them with the necessary treatment, that is, surgery.
- Second objective is to detect glaucoma cases by routine tonometry and in suspected and proved cases of glaucoma, to refer them to the base hospital for treatment.
- To prescribe glasses for refractive errors.
- To detect and treat (operate when required) diseases such as pterygium, chronic dacryocystitis and other infections.
- To refer school children in the villages for correcting refractive errors, squint,amblyopia, nutritional deficiencies etc.
- To undertake health education of the community on proper care of eyes and vision.
- To develop and maintain relationship with the community.
- To market the facilities offered.
- To train medical staff and develop their capacity.
Why we need to organise outreach programmes
Most developing countries are now challenged with the problem of blinding cataract and a huge backlog. Over 60% of this blindness is due to cataract which can be cured by a simple surgery.
In the rural areas where health care facilities are primitive, blindness is more pronounced (1.62%) constituting over 75% of the population) than in urban areas (1.03%).
Free eye camps are a major step in this war against needless blindness. They provide a link to the rural masses by reaching out, seeking the needy patients and restoring their vision.
Community outreach activities
An eye camp is an activity in which a medical team from the hospital visits the village and examines people's eyes to detect any problems. Those with eye problems are offered the necessary treatment either at the campsite itself or at the hospital, depending on the nature of the problem.
Different types of outreach programs
Screening (diagnostic) camp
The medical team examines the patients for eye problems and treats minor problems on the spot with medication. People who need surgery or speciality care are advised to come to the base hospital. No surgery is performed at the screening camp.
Outreach surgery camp
In places like Nepal and Afghanistan where the populations are scattered it is impractical to take the patient to the base hospital. It is advised to perform cataract and minor surgeries like DCT, pterygium, chalazion etc. in a fixed facility at the community level.
Village volunteers programme
In a study conducted by Aravind Eye Care System, London School of Hygiene Topical Medicine and an NGO at the community level on the uptake of eye care services through eye camps, it was found that only 7% of the people who need eye care services in the target village (which is within 5 kms of the camp site) were aware that an eye camp was conducted. It is neccssary to increase and improve the eye care service delivery to all the needy people in rural, tribal and inaccessible areas and involve the community based social service organizations, which are engaged in different health care activities in terms of trained volunteers, to identify all kind of ocular defects and vision impairments. The involvement of the NGO, commitment of the volunteers, efficient and effective training at the base hospital, scientific ways of identification and mobilization of needy people, can help these become sustainable. It is a continuous process to create awareness at the community level.
School eye health scheme
It is estimated that 5- 7% of school going children (up to 15yrs) have eye defects. Refractive error accounts for 5% of the total defects. In order to optimally utilize the resources, it is advisable to train school teachers (1 teacher : 100 children) to assess vision.
Role of OA in the eye camps
As a student
Eye camp gives a lot of opportunity for the OA to see a variety of cases in these outreach camps. Those who attend camps utilize the opportunity to improve clinical skills. They can also see patients with diabetic retinopathy, glaucoma, retinitis pigmentosa in camps. These are the patients who are not normally reaching a hospital in time. Most of the patients are not able to access the service. Since we go to their doorsteps we are able to see these cases, examine and counsel them. Pupil examination forms an important aspect of ophthalmic clinical examination. Abnormalities can give information for diagnosis. It can be caused by an optic neuritis, or glaucomatous optic atrophy.
Cataract screening alone does not form a comprehensive approach in eye camps. By neglecting camps, a trainee looses the opportunity to see cases in large numbers. Over a period of time, the trainee, learns many things by their mistakes. Seniors are there to help the students in dealing with the complicated cases and decision-making. Learning is an art and it comes from practice.
As a leader
For an OA, eye camps are challenges to develop individual leadership capabilities. Coordinating the whole team, maintaining discipline, punctuality and culture of all involved are to be taken care of.
The cordial relationship with the sponsors who conduct eye camps, an informal talk, a friendly smile make them feel comfortable. The quality of leadership makes the camp sponsor not only satisfied but also willing to continue the service to the community. Listening patiently to the complaints of patients and communicating in a proper way is essential rather than just examining with the torchlight and directing them to the next stage in the camp.
As a team worker
An eye camp team consists of doctors, OAs, patient counsellors, optician and camp organiser. As a team member, coordinating important tasks with the help of other staff forms a major step for the success of a camp. The OA creates a team spirit in the group and arranges to see a large number of patients in a quick and orderly way. The OA should not work as an individual but work as a buffer to improve the quality of the team. The accountability of the team is a result of the contributions of each member of the team.
Magnitude of blindness in India
Blindness due to cataract still remains a big challenge to both the medical and social welfare fields. Most developing countries are now facing the challenging problems of blinding cataract, with a huge backlog and a growing elderly population contributing to the increase of new cases. A national survey conducted in 1987 by WHO - NPCB shows an increase in the prevalence of blindness due to cataract from 55% in 1975 to 80% in 1987 and in Tamil Nadu 88% of total blindness is due to cataract.
The total population in India is over 1 billion of which 75% lives in villages which have very few eye care facilities. In India out of 30 million eyes, only 3.5 million is operated every year. In Tamil Nadu 3.6 lakhs eyes are operated, of which 60% of surgeries are performed by Non Governmental Organizations. These statistics shows the magnititude of the problem and the importance of private hospitals handling the problem. An outreach programme plays a vital role. The village people will feel comfortable with them as they talk their language. They also can go down to the villager’s level of understanding and explain their disease and make them give their consent for surgery or treatment.
The OA learns from this unit the importance of conducting outreach programs. This program goes to the door step of those who need this type of medical help and helps them to enjoy the benefits. The different types of outreach programs enable people of all age levels to get assistance.
Key points to remember
- The problem of blindness particularly in developing countries is not solely a medical problem but also a social one
- The social and financial hardships created by blindness gravely affect individuals, families and the nation at large
- There are different types of camps
Answer the following
- What are the objectives of outreach program?
- What are the types of camps?
- What is the role of OA as a trainee?
- What is the role of OA as a team member?
- Write a short note on the magnitude of blindness in your country.