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| EDITORIAL |
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| Year : 1955 | Volume
: 3
| Issue : 4 | Page : 83-86 |
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Ophthalmic relief vs. prevention of blindness
SN Cooper
India
Correspondence Address:
S N Cooper
India
 Source of Support: None, Conflict of Interest: None  | Check |
How to cite this article:
Cooper S N. Ophthalmic relief vs. prevention of blindness. Indian J Ophthalmol 1955;3:83-6 |
In Vol. II No. 2 of our Journal we published two letters, one from Dr. Bakre (Jalgaon) and the other from Dr. Victor Rambo (Mungeli). We invited readers to express their views on rural ophthalmic relief but so far we have not received any reply. Both the writers expressed the true scientific and missionary spirit so necessary to tend to our countless millions of blind. We have started our associations for the prevention of blindness, it is one of the objects of our Society. and there is hardly a presidential address at our conferences that does not stress the necessity to reduce the incidence of blindness. Every year a 100 or more "eye-camps" are held in different parts of India and we have several mobile ophthalmic units working round the clock. Have we succeeded in that grand design of preventing blindness?
In this great humanitarian problem, a line of distinction has to be drawn between ophthalmic relief to the blind and prevention of blindness. Relief to the blind comes through pity, which activates philanthrophy at both Government and private levels which is responsible for the creation of "mobile units" and "eyecamps". The concern of these organisations is to offer relief to the blind, most of whom are cataract and glaucoma cases that have already spent the most useful years of their existence. Some of these organisations have drifted into mere machines for removing cataracts and performing one type of glaucoma operation for all varieties of glaucoma. These organisations though useful have also a dramatic background. They go into operation with a publicity like those of election-campaigns, complete with prayer and all, and they earn applause from the press and the public, and even a "chakra" from the government. Their work is easy. their performance dramatic as each "pearl" is pulled out of the eye to the utter bewilderment of the volunteers, relations and ministers who throng to the operator's side, many times regardless of asepsis. On the credit side what they actually achieve is sufficient eye-sight for an old person whose, in the words of Dr. Bakre, "remaining span of life does not exceed 10 years, and whose ambition in life after getting sight does not go beyond doing the daily ablutions without anybody's help."
On the other hand there are countless millions who have been rendered blind through ignorance and charlatanism. Here, very often the victim is a child or a very young person who has not reached the prime of life and his blindness is incurable. This is due to the use of strong irritants which have been used as ocular remedies through the ages, and which are continued even in this age of antibiotics, and chemotherapeutic agents. These are the cases which present a real problem to the social worker, the ophthalmologist and the government. These are the cases for which our hearts bleed and for whom we must raise a crusade. These are the cases which are turned away from the eye-camps with the pithy remark, "nothing can be done." The so-called eye-camps are impotent to tackle this problem until and unless the ideals for winch these eye-camps are held are clearly defined and carried out.
At present this problem of rural ophthalmic aid in some of the states is tackled partly by government, partly by private charitable organizations and partly by private adventurers, the latter usually young ophthalmologists in search of operative experience. This arrangement has created jealousies and a spirit of non-cooperation between the different organizers and although a certain amount of relief is brought to the otherwise neglected and forgotten rural population it is distinctly not the correct approach.
Again as remarked earlier a major part of blindness in our country comes from ignorance and reliance on out-dated, out-moded remedies that have been handed down from generations with an obstinate belief that they are still the best. It is this problem that no hospitals or eye-camps can tackle unless there is incorporation of an educational programme along with medical and surgical relief.
The activities of the Bengal Association for Prevention of Blindness, as will be seen from its 26th Annual Report published on p. 88 of this number, not only include a laudable educational programme but a programme for determining the number and kind of blind in our villages.
One more cause for blindness in the villages is extreme poverty and lack of transport which precludes the poor farmer in the interiors from seeking medical aid.
The ideal to achieve would be something like what we find in the present issue of Dr. Mohanlal's description of ophthalmic organisations in Russia. To simplify this approach there should be ophthalmic relief at 3 levels, (1) a university-city level, (II) the district level and (III) the rural level.
I. At the university-cite level will be found the well-organized city hospitals and colleges manned with the highest qualified and experienced personnel where the main objects should be (a) training and education of ophthalmologists, (b) ophthalmic research and (c) surgery requiring a high degree of technical skill and experience. Of these we find several shooting up high above ground-level, at a great cost but with no experienced personnel to man them. They are highly decorative, prestige making for the government and too costly to run. They will serve wonderfully well for research work in years to come but not at the moment without the help of experienced personnel, trained in research work. It may be noted here that the mere securing of the highest university degree does not make a teacher out of the recipient. It needs at least 15 years of personal experience. He can well be chosen from the district units (see below) either by competition or by the credit of his record.
II. The most important units should be the district units. The objects of this unit should be (a) Ophthalmic relief, (b) a training ground for the budding teacher, (c) an educational institute for the subordinate medical service and (d) an educational centre for the population for prevention of blindness and other matters of general hygiene. Some of the "mission-hospitals" serve admirably at this level and it is here that we find the lack of enthusiasm on the part of the government. For the cost of one new city-hospital and college the government can build and maintain 10 district hospitals which can serve a very large proportion of the rural population effectively and efficiently, taking away a big burden from the city hospitals where always there is shortage of space.
(a) and (b) We do have quite a number of civil hospitals, where the civil-surgeon is in sole charge of all matters medical including the administration. It is in these hospitals that ophthalmic departments. well-equipped and manned by an ophthalmologist should be concentrated upon. It is here that the qualified ophthalmologist will find the wealth of clinical and operative material which will serve him in good stead when later he becomes a teacher or a research-worker , in a University hospital.
(c) As regards the subordinate medical service, it must be realised that all medical graduates cannot become teachers or research workers. At the same time a medical service of a lower calibre is required to attend to the routine work e.g. refraction and washings which can be easily entrusted to a trained medical personnel not highly qualified, leaving the head of the department to tackle the more intricate and technical parts of the examinations and treatment.
With the achievement of independence our country has seen the end of this subordinate medical service of "licentiates" who though playing second fiddle were playing an important part in the symphony of medical services. This service has perhaps been abolished in order to boost and encourage the practice of indigenous medicine. What the government fails to realise is that what is urgently needed is a medical service equipped to carry out the routine work which the practitioners of indigenous medicine are not prepared to do.
(d) It would be to our advantage if the Government reconsiders the reenactment of this service. This will relieve the acute shortage of Doctors particularly for out of city work. The training of such licentiates can easily be carried out in these district hospitals which can be upgraded for the purpose. Even so, the mission hospitals which were at one time fulfilling this great task and providing for a great want, are willing even today to restart the licentiate course if they are given the chance to do so, as can be seen from Dr. Rambo's letter. Naturally these hospitals will have to be more fully equipped with regular departments, and as far as we are concerned with a separate eye department with an ophthalmic head.
(e) As regards the education of the public against ancient remedies which have outlived their usefulness, and for the hygiene and care of the eyes, these hospitals will serve as a wonderful background. Propaganda for social welfare with films and slides showing the dangers of irritant and obsolete remedies will serve much to educate the receptive mind of the average farmer. It would be insulting the intelligence of our common folks if we say that such propaganda would be of little use. One will be agreeably surprised to realise how these uneducated people follow the doctor's advice when it is explained to them in the proper way. Here the social worker plays an important role, and he or she is put on the job of caring for the eyes even before the baby is born. Again the social worker must realise that it is not only a child with an ailing eye that has to be taken to the doctor, but children with healthy eyes should also be taken at regular intervals to the ophthalmic department.
When the child starts going to school, the burden of the prevention of blindness in school children must fall on the teacher of the primary and secondary schools. These teachers must have sufficient training to recognise a sore eye or a faulty habit in reading, and at once to direct the child to an ophthalmologist.
In trachoma-infested localities, teachers have been taught to give regular medications to the afflicted eyes of their students and this happens to be also the programme of the W.H.O. in tackling the Trachoma problem. It is here that the child will be able to receive its regular uninterrupted treatment economically.
III. Finally comes the problem of reaching ophthalmic aid to distant populations. Here as already stated the problems are extreme poverty and lack of transport. Here, "Mahomed" will have to go to the mountain. This can be achieved by regular and organised sorties from the district hospitals, each district to cover certain talukas at regular intervals with the help of a mobile unit.
Thus the nucleus of each eye-camp will be the ophthalmic department of a district hospital. The equipment, educating material and personnel of the department including the social worker will serve also for the use of these mobile units, and there will be no need for a separate personnel and equipment for these units. The education programme for the district unit will be carried out also at the time of these eye-camps. Only in this way it will be possible to reach the remotest corner of each Taluka and thus ophthalmic aid and propaganda against blindness will reach the maximum number of our population without encumbering the farmer to travel to the district hospital.
Advantage should be taken, therefore, of these eye-camps to introduce other activities into them, as in the case of the Bengal traveling eye-dispensaries, like an educational programme, determining the number and kind of blind in village populations or other items which directly or indirectly help to reduce blindness, and not be content with offering ophthalmic relief.
Thus by separating the functions of the University Hospitals from the District hospitals, the former confining itself to research and education of the skilled ophthalmologist and the latter to ophthalmic relief, propaganda for prevention of blindness and training of the subordinate medical staff, a maximum degree of efficiency will be reached in all forms of ophthalmic problems without the clashing of interests of the different organizations. Such an arrangement will have an organized plan without the haphazard and irresponsive arrangements obtaining in many places at the moment.
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