|Year : 1982 | Volume
| Issue : 4 | Page : 185-190
Chief Medical Officer, Gandhi Eye Hospital, Aligarh, India
J M Pahwa
Chief Medical Officer, Gandhi Eye Hospital, Aligarh
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Pahwa J M. Presidential address. Indian J Ophthalmol 1982;30:185-90
Hon'ble Chief Guest, Dr. B.K. Mitra, Luminaries on the dias, Distinguished Delegates, Ladies & Gentlemen.
Please permit meat the very outset to express my sincerest gratitude to you all. for electing me to this exalted office of the president, All India Ophthalmological Society, for the year 1980-81. I am fully conscious that this honour in the past has been bestowed upon 'Doyans' of our field and I have, therefore, greater reason to be thankful to you all I am fully aware of my limitations but as a devout soldier and humble worker I promise you that I shall try my very best to prove worthy of the confidence that you have reposed in me.
We are meeting today at the historic city of Udaipur, a place known not only for its warm hospitality, which I am sure will make our deliberations more pleasant, fruitful and rewarding.
I must confess that making speech is not my wont. If given the choice, I would rather tike to stay back in the Operation Theatre than to mount the platform and deliver a speech before the distinguished gathering like this, but I just cannot help as it is expected of me to do so. You will, pray, bear with me for some minutes to hear rather an unconventional address.
The All India Ophthalmological Society is now more than 50 years old. From its humble beginning it has grown to its present stature with a membership of nearly 2000. As you are aware the society has embarked upon multifareous activities. Several new Orations and Awards have been instituted. Recently a Scientific Research Fund has also been created under which visiting Scientific fellowships are to be awarded. Besides this, pre-conference courses, which started 3 years back have proved very useful and popular. It is, therefore, intended to continue them with of course related surgical sessions as well.
Our conferences are becoming very popular every year, as is evident by ever increasing delegates attending them. The quality and scientific value of papers during these years has also improved a great deal. There are so many excellent papers that it often becomes very difficult to accommodate all of them during the limited period at our disposal in the conference. 1 can thus visualise that after sometime holding of these Annual Conferences, will be possible only in big metropolitan towns. We will also have to consider convening Regional Conferences as well. This is indeed a matter of great satisfaction and pride for us. I pray to God. Almighty that our Society grows and flourishes still further.
First of all, I will like to make by humble appeal and request you all that we should become members of the I.M.A. i.e., our parent body and strengthen this association. I.M.A. as you are all aware is concerned with the delivery and provision of primary health care including Eye Care to the rural population.
You have been hearing excellent and eloquent Presidential addresses during the past years. They have been covering various aspects of profession. Some were technical and Scientific while others historical and philosophicat. These addresses rightly stressed the need for a seperate discipline of Ophthalmology in undergraduate studies, the need for a practicable corneal grafting act and manufacture of diagnostic and therapeutic instruments indigenously, availability of Ophthalmic lenses etc. All these problems indeed are very important and the Society is fully seized of this and will continue to do whatever is possible to achieve the desired objectives, and to attain self-sufficiency and self reliance particularly in manufacture of modern sophisticated ophthalmic instruments. Today, I stand here and propose to deal with only a few problems, wnich to my mind need priority and have greatly interested me.
The Postgraduate Medical Education needs re-orientation. The Ophthalmologists shoulc prevail upon Medical Council of India to re-orient the Postgraduate teaching programmes and courses, in such a way that they meet with the specific requirements of our country. Today, the existing Western model of medical education and training is suited to export market and is not for our national consumption. It is very essential that the teaching programme and standards for Post-graduate education in all medical colleges and Universities must be uniform. There should not be any unholy competition for setting up Postgraduate Deptts. in every Medical College unless full facilities for teaching and research exist. The procedure for admission and criteria must also be clearly spelt out. No consideration, other than merit, need be taken into account We have two types of distinct postgraduate courses i.e., Diploma course and Master degree course. The former should be so oriented that after having passed this diploma course the Ophthalmologist is trained to practice ophthalmology without any difficulty. But for degree course i.e. M.S. or MD., the training and teaching has to be very extensive and intensive with the chief purpose to train the candidate in all aspects of ophthalmology including research methodology. Here the teaching and training has to be of a very high order. Nothing less than the best will be good enough, for upon training of our Ophthalmologists, depends the destiny of visually handicapped of our fellow countrymen. This responsibility lies fairly and squarely on the medical teachers, who should be wholetime teachers devoted to Teaching and Research, To the teachers, private practice should be completely banned, but they must be adequately financially compensated for the loss of private practice. The teachers owe to the Nation that they inspire and engage upon very high quality of research. There is plenty of scope for improvement in research. To my mind it should mainly be need oriented for our country. The young ophthalmologist engaged in research should receive encouragement and best infra-structure and atmosphere must be created for them to work smoothly and profitably. The quality of thesis for the degree i.e. M.S. or M.D. must be up-graded.
A list of thesis submitted during the last 10 years in all medical colleges should be available to the Postgraduate so that it is ensured that there is no duplication of work and consequently waste of efforts. It is greatifying that National board of examination has been constituted. The M.N.A.M.S. examination conducted by this board should not be just repetition of M.S. examination of other Universities. It will be better if it lays more stress on super specialities, like Corneo-Plastic Surgery, Retino-Vitreal Surgery, Orthoptic and Squint and Ocular Pathology etc. This academy should also organise seminars, symposiums and workshops under their programme of "Continuing education" for all types of disciplines.
Now, I would like to draw your kind attention to the problem of curable blindness in our country. Every Ophthalmologist whether he is a teacher, research worker or practitioner will acknowledge that the problem of blindness in India is simply staggering. You are aware that there are about 9 million blinds and 45 million visually handicapped in our country. It has been estimated that nearly 4.5 million blinds (45 lacs) in our country are curable, which means that they are needlessly blind. How can we sit back and relax when the basic human right i.e. right to see is denied to so many millions. We must ensure that no one goes blind or being blind, does not remain so. The problem though seems insurmountable and difficult but not incurable. Only humanitarianism or helpless hand-wringing pity for the blinds is not the answer. There is no doubt shortage of Ophthalmologists, para medical staff and even funds, however, the right thing would be to face these challenges squarely, pool our resources and do whatever we can. All poor and blind cannot reach the ophthalmic centres for one reason or the other. It is our clear responsibility and sacred duty to "Reach them and Restore Sight". It is their due.
Realising the Himalayns magnitude of this problem a "National plan for prevention & control of Blindness" was drawn up with the main objective of providing Eye Health Care to the community through 80 mobile units. 2400 primary health centres, 2000 sub-divisional hospitals, 106 medical colleges and 6 regional and one apex Institute. The main genius behind this plan and programme, you all know, was our esteemed friend prof. L. P. Agarwal. It was indeed an ingenious plan worked out in details and would have achieved its objectives if all would have gone well as planned and finances and resources were available in different states. It was a great pity that when the progress of the plan was reviewed 2 years after it was launched, it was found that it has not been so successful as was initially expected. The progress was tardy and the objectives were not being achieved Many mobile units were lying idle and those which were in operation did not achieve even half of their targets. It was also realised that there was more stress on cataract surgery rather than on health education and preventive ophthalmology. It is very gratifying to learn that the plan has now been reviewed and recast. The machinery for its implementation has been stream-lined and geared, and more central assistance has been made available to the states. I wonder if it would be better that the plan is decenteralised and instead of one plan it may run as multiple plans in each state.
It is our duty to make the national plan successful. If we as ophthalmologists are really serious and sincere, there is no reason why the different states will not adopt and implement it. If we search our conscience, we will find that we are also lacking in our duty. Most of us do not have time or inclination to work for community ophthalmology. We only aspire for private practice, equipment, mobile units and other facilities for upgrading departments, but we really do not wish to do any additional work for the benefit of the rural community.
The problem of curable blindness due to cataract alone gives us some insight into the dimensions of the problem of blindness and for commnnity ophthalmology. You are already aware that nearly 6 lac cataract operations are done every year in our country, but another 5 lac new cases are added. Unless we operate 10 lac cases per year, it will not be possible to eliminate blindness due to cataract within the next 10 years. I will, therefore, appeal to you one and all to take a pledge and vow today that we will operate at least 100 more cases every year. We ophthalmologists, who are 4500 in number can achieve the target of eradicating curable blindness within the nev 10 years without leaving back log.
Another question towards which I like to draw your attention is the training of paramedical personnels like optometrists, orthoptists and theatre assistants etc. Today there are only 2000 optometrists in the country. Every effort should be made to train larger number of optometrists and ophthalmic assistants. May I venture to make some suggestions for our National planners.
1. Six Regional Institutes should be so located in the country that the eye patients find them within convenient reach MP., Rajasthan & Bihar should not be ignored while locating these Regional Institutes. The existing Institutes should be strengthened, and asked to do more.
2. The ophthalmic departments of all medical colleges should have a separate community ophthalmology wing. This section would hold the eye camps in rural areas without affecting the routine, teaching and research work. The number of existing mobile units must be at least doubled and their allocation and execution must be given top priority. The mobile units should work throughout the year, especially in inaccessable backward and/ hiil areas. Local resources and talents available in the districts must be fully explored and mobilised. The voluntary organisations and big eye hospitals, which are rendering services to the community for many decades should also be helped to improve upon their work and expand their activities by providing them with more mobile units, equipment and instruments etc. Private practitioners should also be involved by the Government in the rural eye relief work. I will even suggest that instead of 2 vans per unit, only one may be given to effect economy, but to achieve more results. Some incentives can also be announced for real good results in rural areas as is done for family planning work.
3. Different medical colleges should be provided facilities to start Diploma course in consultation with the Medical Council, of India but M.S. course, as mentioned before should be restricted only to those medical colleges which have adequate facilities for teaching and reserch. For this purpose a rigid yard stick should be flexed and strictly adhered to. To provide more medical personnel for the immediate need of our National plan, I would suggest that there should be extensive training during one year House job in Ophthalmology. This programme can also be started in wellequipped eye hospitals having 50 beds or more and band of qualified Ophthalmologists. Such doctors after having received this extensive one year training can be utilised in the mobile units for 3 years on contract as incharge of the mobile units. After this period of 3 years they should be allowed to register themselves for their postgraduate qualifications. Thus certain amount of quota should be reserved for admission on such trainees.
4. To produce optometrists, more and more Schools of Optometry should be opened. There should be at least one school in every State. They should impart training for 2 years' Diploma courses to students with Intermediate with Science as basic qualification. The already existing schools should be reinforced and be provided with sufficient funds for more staff, equipments and library etc, and if necessary two shifts can be started in such schools.
The proposed six months course to my mind is not a correct step-rather a retrograde one, because six months are just not sufficient for training-theory and practice of Refraction. As you all are aware that refraction work has to be done carefully and wrong glasses can be more harmful than not using them. The pay scales of the optometrist throughout the country should be made uniform. An act to regulate services of opticians is absalutel essential to put a bar on unqualified persons, who run the optical trade and do refraction work.
5. To produce sufficient number of orthoptists, we should continue to have a separate 2 years diploma course in Orthoptics. Such courses can also be started in Regional Institutes. Girls should be given preference in admissions as most of the patients are small children and girls have a natural tendency to inspire confidence in them. Jobs should be created for orthoptists in every Medical College and big Eye Hospital to run the Orthoptics pleoptics Department. It has been rightly said that without a good orthoptic department, the ophthalmologist is just like a person without a limb.
6. More and more attention should be given to preventive side of ophthalmology as majority of blindness is preventable. For this purpose, a programme for educating our masses, especially those living in rural areas must be launched. Through this programme, we should try to educate them in personal hygiene, common eye diseases, diet, reading habits and make them aware of availability of Eye Hospitals and Eye Camps in the area. The services of Radio, Television, press and other means of communication media like film on eye care in regional language should be utilised. Special chapters on care of Eyes should be included in the books prescribed for courses in all the classes. I will also suggest that alongwith treatment prescriptions to patients, a small pamphlet regarding care of eyes must be enclosed in regional languages.
7. The rehabilitation of the blinds and visually handicapped in our country has not received as much attention as it requires. It has to be further intensified. Efforts should be made to create facilities for education, training and rehabilitation of the blinds. There should be plenty of jobs opportunity for such people. This year being the "INTERNATIONAL YEAR FOR THE DISABLED" demands our special interest and attention.
Ladies and Gentlemen, the task before us is stupendous, the challenges many but we have to face them adequately in the interest of the millions of eye sufferers. This cannot be solved by the Government of our country or state Governments alone. Hence the cooperation and active involvement of all the ophthalmologists is needed. If we all join hands and make efforts, there is no reason why effective solution to our problem cannot be found. The programme of reaching them by scientific eye relief camps at their very
door steps must find a rightful place in our professional life. If we can replace blindness with light, I am sure we too will feel light with in us. Really there is no better way to thank God for our sight than to give sight to someone else. Has not Alexander pope, the famous British poet said, The greatest service to God is to serve mankind'. We have to realise our responsibility towards our fellow blind country men and lift them from the morass of despondency and uselesness.
Swami Vivekananda once said "Where: should you go to seek for God?
Are not all the poors, the weak, the miserable Gods?
Why not worship and help them?
Why go to dig a well on the shores of the Ganges?"
I am sure that all of you, who are "Merchants of light and knowledge" are in a position to save the vision and restore the sight of countless number of blinds or nearly blind, who oherwise are doomed to a life of misery and darkness. I may remind you all that our country is committed to "Alma Ata declaration" which sets the goal of "Good health including good Eyes for all by 2,000 A.D." For this I will give my humble slogan "REACH OUT AND RESTORE SIGHT".
Ladies and Gentlemen, I must again thank you for having reposed the confidence in me by electing me as your President. I can only assure you and promise that I will make my humble efforts to raise the status and prestige of our Society and Indian Ophthalmology with your help, guidance and co-operation.