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| ARTICLES |
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| Year : 1955 | Volume
: 3
| Issue : 4 | Page : 73-76 |
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A visit to Russian ophthalmic institutions
Mohan Lal
Gandhi Eye Hospital, Aligarh, India
Correspondence Address:
Mohan Lal
Gandhi Eye Hospital, Aligarh
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Lal M. A visit to Russian ophthalmic institutions. Indian J Ophthalmol 1955;3:73-6 |
To the average Indian at the moment, everything Russian strikes a great fancy and it may seem to him that Russian medicine, surgery and ophthalmology are far superior to the same sciences practiced in other parts of the world. I may premise straight away that there is nothing phenomenal about Russian medical science. It is at best about equal to any and second to none as practiced in the different countries of Europe and America. What is phenomenal is the progress the Russians have made in these sciences starting from almost scratch about 20 years ago. It is the rapidity of this progress, the institutions that have sprung up and the training that has been imparted, that is phenomenal. When we are told of the conditions that existed 30 years ago and compare the same to as we find to-day we cannot but help calling "shabash". We were particularly impressed with the clarity with which medical problems, including ophthalmic, are appreciated and tackled in specific ways the approach being changed to suit varying conditions from time to time.
I have always been anxious to compare the scientific institutions and methods of foreign countries with our own and find out as to what modifications in our plans and practical work were necessary to develop our Indian institutions on a sound basis, so that they may serve as models in the Ophthalmic field.
With this aim and end in view, I visited, as a member of the Indian Medical Delegation to Russia, several Russian institutions, and also those in the U.K., Germany and Austria, and discussed several problems.
Among the institutions I visited in Russia were:
(a) The Ophthalmic department of the Medical Institute Tashkent in Uzbekistan-a training centre for under-graduates and directly connected with the anti-trachoma campaign.
(b) State Scientific Research Institute of Eye Diseases after Gelmyolts in Moscow which gives a diploma in ophthalmology, (the recipients are called ordinators) and prepares medical men for submission of thesis for Doctorate.
(c) Ophthalmic section of one polyclinic at Tblisi, which gives relief at the district levels.
(d) Ophthalmic section of one rural Hospital which gives relief at rural levels.
(e) Filatov Institute of Ophthalmology in Odessa. This is the most important and biggest institute in the U.S.S.R. for research in ophthalmology and for training to post-graduates. Under the personal guidance of Academician Filatov this Institute has done original work on Transplantation of the cornea and tissue therapy. It also trains Ordinators and prepares Candidates for the submission of thesis for the qualification of these Candidates for the Doctorate. No undergraduate training is given at this institution which is purely a post-graduate and an independent institute. It has earned the 'Red Flag'-the highest honour in the country awarded to an institute for scientific work.
Besides these we saw a few health services attached to collective farms and factories.
I would submit my observations on several points, followed by suggestions, that may be applicable in our own country, keeping in view our national needs, and limitations.
| Basis of Medical Planning in Russia | |  |
The cardinal feature of the Russian Planning of their medical organisation is to assess the needs of the various parts of the country and to train the requisite number of medical men in their five years plans. It is the Union Government at the centre which directs the number of medical students to be admitted all over the country. Therefore, while they have fixed a target of the ratio of population to one doctor, they go on modifying this radio in the light of development of industries and. farming etc. requiring more expanded medical service.
Similarly the Central Government approves the Budget of the Republic and exercises a definite control on the allocation of funds to various states, thus utilising surplus funds from the State for a backward State, and executing its plans on a uniform basis. The main consideration is the health of the nation and the authorities are guided by this principle in planning this medical education and relief.
In contrast with the present Indian Policy of putting Ayurvedic and indigenous medicine at par with the modern system of medicine, the U.S.S.R. which also has its system of indigenous medicine has adopted the policy of tolerating these systems so long as their medical relief is brought to the desired standard and to incorporate in the modern system any good points discovered in these indigenous systems.
| Ophthalmic Training in the Medical Colleges | | |
Ophthalmology is taught as a separate subject in the U.S.S.R., but greater attention is paid to the post-graduate training.
Refresher courses are given to the medical personnel working in the peripheral hospitals or dispensaries. This is given in two installments of 6 months each at the Rural Hospitals which are run by personnel trained in the various specialities.
Post-graduate qualifications are obtained after a number of years of study in various institutes and are of 3 categories.
Graduates are trained to become Ordinators in Ophthalmology after a 3 year course in the medical institutes. The Ordinator spends 6 months each in various aspects of the subject e.g., O. P. D., Orthoptics, Refraction, Operation, Laboratories, Glaucoma Clinic and X-rays. After this training is completed he is supposed to have passed his Diploma examination in the usual Russian manner. He is now entitled to be appointed as a specialist in a polyclinic or City Hospital.
It may be noted here that in an Institute with 300 beds and a permanent whole time non-practising staff of 8 professors and 25 candidates (see below), only 7 Ordinators are admitted for this Post-Graduate training as ordinators. This includes the value that is attached to the Post-Graduate training in that country.
From among the Ordinators, those who have a special aptitude for teaching and ophthalmic research are allowed to submit a thesis, which if accepted, designates them as Candidates. The number of such "Candidates" is restricted to only 25 of those who appear for the examination of Ordinators. This qualification is higher than "Ordinator" and equivalent to the position of a Dozent on the continent of Europe.
A further 3 years training makes the Candidate eligible for the `Doctorate' for which also a thesis is required to be submitted. Again only 25% of those who submit the thesis are allowed to the "Doctorate".
| Research in Ophthalmology | | |
Research is carried out at Medical Institutes or at Scientific Institutes of higher training. All these are maintained by the Ministry.
Corneal Transplantation has advanced very much in the U.S.S.R. They have started operating on children as young as 18 months in age. Another advance is the subtotal keratoplasty done as a primary step to a subsequent partial penetrating transplantation. Corneal transplantation is mainly concentrated in Odessa, which has helped to develop this surgery.
Substantial work has been done on Tissue Therapy which is widely practised, not only in Ophthalmology but also in other fields of medicine.
Xerosis is treated by the transplantation of the salivary ducts into the conjunctival sac.
Glaucoma has become their very special problem for research in recent years. Mass examination of all people over 40 years of age is carried out on the clinical and preventive side.
Of note are some of the special instruments they have devised e.g. syringes for injecting tissue, special scissors for transplanting parotid gland in the conjunctival sac, corneal trephine, and the Filatove-Kalf tonometer.
| Antitrachoma Campaign | | |
Parts of Russia fairly well infected with trachoma, the campaign against trachoma is well planned.
(a) States affected with trachoma are divided into regions of about 40,000 people.
(b) A team consisting of doctors who had received a special training in trachoma work and middle medical personnel, totalling about 15 persons in all-is sent to each of the above regions.
(c) Each team stays for 3 months in the area, when they make a house to house search record and treat 2nd and 3rd stage trachoma cases. The fourth stage cases being uninflective are left alone. The treatment is continued by the middle medical personnel and local personnel who are given training in administering the treatment.
(d) After 3 months the team returns to the head quarters where it works for the remaining months. It returns to the same area the following year.
The team also performs operations for cataract and brings other types of ophthalmic relief to the "areas".
(e) With development of more and more permanent institutions manned with trained staff, these sorties become less and the work is taken up by the local rural hospital which keeps an eye on any fresh trachoma infection.
(f) Every student is examined for trachoma and if found infected is isolated and treated.
| Summary | | |
A brief account is given of the author's visit to Russia with special reference to (1) basis of medical planning, (2) ophthalmic training in the medical colleges, (3) research in ophthalmology and (4) antitrachoma campaign.
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