|Year : 1988 | Volume
| Issue : 3 | Page : 107-108
Cataract blindness and manpower planning
CBM Oph. Institute, Little Flower Hospital, Angamally-683 572 Kerala, India
S T Fernandez
CBM Oph. Institute, Little Flower Hospital, Angamally-683 572 Kerala
|How to cite this article:|
Fernandez S T. Cataract blindness and manpower planning. Indian J Ophthalmol 1988;36:107-8
Unprecedented draught, heavy floods and major train accidents are listed in the category of national disasters. And rightly so. Hundreds of people die, thousands are maimed and hundreds of thousands loose their shelter and life earnings in such disasters. To most of them, these experiences are tantamount to the light in their lives being extinguished.
But another major and recurrent disaster of national proportions, which also causes permanent loss of light to millions of Indians each year does not get the priority it deserves. This is the disaster of blindness, particularly, that caused by cataract. The oft-quoted 1972-73 survey conducted by the Indian Council of Medical Research (ICMR) established that there are 9 million blind people in India. It stated that a staggering figure of 5.5 million were blind due to mature cataracts alone. A scientifically planned and efficiently executed National Programme for the Control of Blindness (NPCB) was started in 1976, thanks to the foresight and efficient leadership given by Prof. L.P. Agarwal, the then Director-Professor of the Rajendra Prasad Centre for Ophthalmic Sciences and advisor to the then Government of India, The late Prime Minister Mrs. Indira Gandhi and her administration were fully committed to the programme and prevention of blindness and hence it got its priority in the 20 point programme. Primary health centres, taluk hospitals and district hospitals were upgraded. Medical Colleges and regional ophthalmic centres were given maximum help. Thousands of camps were conducted every year, both by the governmental agencies and voluntary organisations. It is estimated that about 1 million cataract operations were conducted every year. The excellent work done by the doctors, paramedical staff and voluntary organisations was laudable. Inspite of all these efforts, the incidence of cataract still remains a great problem. The reasons for this are many. The population has been increasing at a rate of 2.25% every year. We have to take into consideration the decreased infant mortality and increased longivity of life. The number of living persons above 40 years is on the increase. So also the incidence of cataract, as it is basically a problem of the senile. There are other factors to be looked into as well.
So far the backlog has been calculated only on mature cataracts. As the percentage of literacy goes up and job opportunities increase, more and more people have to be operated at an early stage of cataract. A collaborative study on cataract conducted by Prof. Madan Mohan Chief of the Dr. Rajendra Prasad Centre for Ophtalmic Sciences, New Delhi, under the age is of ICMR and NPCB gives revealing facts. The backlog of mature cataract has been estimated to be around 7.5 million. But if one takes into consideration the visual acuity below 6/60, the figure will go upto 21 million. Many of the surgeons now operate patients who have much better visual acuity. Therefore the figure given above is much less than what is estimated. The demand for a higher quality of surgery will naturally increase. Less and less people will go in for camp surgery - the demand for intra-ocular lens implantation surgery will also go up.
These facts were well brought out by Prof.G. Venkataswamy, Director, Aravind Eye Hospital, Madurai, in his Presidential Address at the Southern Regional Ophthalmic Conference held at Trichy recently. He emphasised the need for steps to increase the training of ophthalmic surgeons not only in quantity but also in quality.
It has been estimated that more than 70% of the cases operated in India are performed under the voluntary agencies without the financial help from the government. The organisations like Royal Commonwealth Society for the Blind, Christoffel Blindenmission, Operation Eyesight Universal, Govel Trust (Madurai), Lok Kalyan Samiti (New Delhi) etc. are extending yomen service in this field.
Many institutes and hospitals run by voluntary organisations are well equipped, efficiently administered and are giving high quality of service to the poor and needy patients. The training facilities available in some of them can be compared to those available in developed countries. The Government finds it difficult to equip their own teaching institutions to the required minimal standard due to financial constraints. The Government medical colleges must be equipped with all the modern equipment like excellent microscopes, scans etc so that a higher level of training can be imparted to the post graduates, andd modern surgeries like intra-ocular lens implantation, retinal detachment etc. can be undertaken. This will ensure benefit of attention at a high quality level, to a greater number of people.
The universities, the Government and Medical Council should also consider utilising the excellent facilities available in some of the private institutions. There are only about 6000 qualified ophthalmologists in India to serve a population of more than 762,000,000. According to Prof.G. Venkataswamy, the number has to go up to 10 to 12 thousands in the next decade to complete the backlog of cataract.
There has been some opposition from a section of Govermental agencies and medical college faculty in involving the voluntary sector in training post graduates in some states. This is perhaps due to false prestige and unfounded anxiety. The efforts of the Government hospitals and medical colleges and the medical institutions run by voluntary organisations can be combined for national good. They can work hand-in-hand to serve the community and impart training rather than compete with each other. Most of the voluntary hospitals are running regular camps in the rural areas, where such services are mostly needed. Many of the qualified surgeons are concentrated in big cities and urban areas, and the government has not yet been successful in attracting these specialists to the rural areas. Thus it is all the more important that the Government should acknowledge the services done by voluntary organisations. If these institutes maintain the basic requirements laid down by the Medical Council, the universities and the Government should recognize them as post-graduate centres. With the most advanced equipment which some of them have and the clinical material they possess, they will be in a better position to impart a higher standard of post graduate training than many government facilities. The services of the post graduates can be utilised for the camp work as well.
Admissions to such institutes can be controlled by some basic norms, to avoid malpractices. If the Universities, Indian Medical Council and Government take a pragmatic view in this aspect, greater strides can be made in the curative and preventive aspect of blindness, which still looms as a great social and economical burden for the nation. Truly a national disaster of frightening proportions.
To sum up, in the national effort at disaster - management as far as cataract blindness is concerned, a two-pronged approach has to be chalked out. First, the Government institutions spread out all over the country should be better equipped so that the dedicated and concerned surgeons working in them will have recourse to the best and the most modern equipment available anywhere in the world. Secondly, the stigma attached to the voluntary sector should be removed forthwith and the excellent facilities available with them should be fully utilised for training many more ophthalmologists. I do hope the national Government will open its eyes to these twin-needs so that many more eyes than present may retain the precious light in them.