|Year : 1979 | Volume
| Issue : 4 | Page : 1-5
XXXVII All India ophthalmological conference, Hyderabad
A V Madangopal
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Madangopal A V. XXXVII All India ophthalmological conference, Hyderabad
. Indian J Ophthalmol 1979;27:1-5
Hon. Chief Guest Rajyapal Smt. Sharda Muckerji, other dignitaries on the dais, distinguished guests, fellow delegates, ladies and gentlemen.
I express my heartfelt gratitude to the members of the society for bestowing upon me this great honour of presiding over the 37th session and electing me as the president for the year. For when I look back at the galaxy of ophthalmic giants that have occupied this chair, I feel humble and overawed at the prospect of trying to justify your choice. I assure you that I will spare no efforts in serving the society, and its members to the best of my ability.
Ladies and gentlemen, we are meeting under a great cloud. Just over a month ago, in the 2nd and 3rd week of November, nature had dealt a cruel blow to our country in the south. Thousands of people had died, thousands have become destitutes, having lost their all. Here I would like to place on record the heartfelt sympathies of the members of our society to those nameless thousands who have suffered in this cataclysmic disaster.
I appeal to members who have not contributed so far to give and give till it hurts, for this worthy cause.
Since past 27 years, our problems have remained static and the concerned authorities base not taken any action through the years.
"While the responsibility of medical and other measures for the treatment and prevention of eye diseases must ultimately fall on the Government, such actions as they can take in this field must largely be influenced by the technical advice and guidance which conferences such as ours can place before the country. The immediate need is to utilise all the resources within our means to extend help to as wide a section of the community as possible particularly in rural areas and in attempting to do so we shall have to seek I feel the help of various types of nonmedical workers such as teachers, nurses, health visitors in addition to that of doctors. In addition a medical aid of higher standard can be made available to the rural population by travelling under charge of trained ophthalmologists. These medical units concerning themselves not only with the treatment of patients, but also with the education of the people in prevention of eye diseases. As a long term measure provision of well developed ophthalmological departments in every district and sub-divisional hospital will be necessary to ensure that the campaign against eye diseases is promoted on a sound basis. In order to assist in the orderly development of such a programme, I would suggest that every province should have an ophthalmic advisor on the establishment of the administrative head of the provincial health service".
Late Rajkumari Amrit Kaur, the then central minister for health, addressed our conference in the year 1948, thirty years ago and said "While the responsibility of ...." How typical the whole thing sounds even today. Last year my illustrious predecessor, Dr Lalit Agarwal, outlined a national programme envisaged by our Government for the development of ophthalmic relief at four levels:
(1) the peripheral at the primary health centre level;
(2) the intermediate at the level of Taluqa hospitals, district hospitals and medical colleges which are not upgraded;
(3) central level with upgraded medical colleges, eye hospitals, and regional institutes;
(4) the apex services centred at Delhi.
After 30 years of independence, we are still planning for this immensely important and vital problem. This is the slow, ponderous manner in which the Government moves and we have to reconcile to the situation.
In the year 1928, one of our founder members late Dr. Zacharia conceived the idea of bringing together all the ophthalmologists of our country under the banner of our society. He said, "we should form a society of all the ophthalmologists in India, society for promoting our well being and co-operation and for stimulating advancement and research in our speciality."
But strange enough all these years we never talked about ourselves; the ophthalmologists. We do not even know our exact number in this country today. How we are distributed in urban and rural areas, in various services and private practice and how the different groups face different problems.
Every year the presidents of international organisation like the Rotary and the Lions announce a slogan for the year. Last year President of Lions international Prof. Sobral gave out the beautiful slogan-"Make your fellow man feel needed," This year during my presidentship this is what I will try to achieve namely make every fellow ophthalmologist feel needed. To begin with I tried to arrive at an approximate census of ophthalmic surgeons in our country by ascertaining the number of ophthalmologists that have passed out through various institutions in our country in the last 5 years. I regret to say that some of the institutions have not sent in their replies, but one has come to the conclusion that a conservative estimate of about 300 ophthalmologists are coming out every year from all the institutions in our country. I, therefore, feel that the number of ophthalmologists in our country today may be about 3500. About 1000 of them are in different services and the rest in private practice. I sent a fairly exhaustive questionnaire forms to all our thousand and odd members, enquiring about themselves, their practice, equipment, environment, and all other factors concerning their working conditions.
The groups can be broadly divided into, those in private practice and those in services. Though only about three hundred members sent in their replies, they represented a cross section of the above groups and the information was quite revealing.
I travelled over 24,000 km. and met nearly 800 ophthalmic colleagues during their state and regional conferences. This gave me a lot of insight into the working conditions of many of our colleagues and their problems. It also gave me an opportunity to visit well-equipped institutions like the Dr. Rajendra Prasad Centre for Ophthalmic Sciences, Delhi, as well as humble ophthalmic clinics in remote areas where our colleagues are bravely carrying on useful work equipped with only a corneal loupe, an ophthal moscope and a modest set of surgical instruments. Most of our colleagues in private practice find that imported ophthalmic equipment are very expensive due to crippling customs duties. I am happy to inform you that since October, 1977, the duties have been considerably reduced so that now instead of 75% to 100% duty that was imposed previously, the level has been brought down to 30% to 45%. Our colleagues also find it a very complicated process to get our equipment repaired here or abroad. Our managing Committee has appointed a standing committee to solve these problems.
Majority of our ophthalmic colleagues in small towns due to lack of difficulties and time find it difficult to keep pace with the rapidly advancing science and practice of ophthalmology. No doubt some of them may be attending the state and all India conferences. But majority of them find them full of theoretical and academic knowledge, without much of practical utility.
The Institutes of ophthalmology at Delhi. Aligarh, Sitapur and Ahmedabad, no doubt, conduct periodically fairly exhaustive workshops ov subjects like squints, corneal surgery, or detachments but invitations to participate in these courses go only to the medical colleges and except for a few chosen ones, majority of private practitioners are ignored. In any case since the courses are too long, lasting from a week to a fortnight, most of our private practitioners cannot afford the time for the same. To meet the demands of private practitioners, our own society has formed a development of scientific research fund committee headed by our past president-Dr. M. Sengupta which also envisages organisation of-
(1) Visiting scientist fellowships:- Our country is divided into six zones-and each zonecan have the benefit of one visiting scientist.
(2) Travelling trainee followship:- This year three candidates have been selected for advanced training under eminent ophthalmologists or institutes.
This year we have instituted a novel idea of organising short intensive study courses for junior ophthalmolgists at the venue of the conference lasting for one day. 110 ophthalmologists took advantage of this. We will assess its usefulness and will perhaps improve upon it next year, adding practical operative demonstrations to theoretical lectures and discussions.
For this, I have yet another practical plan which is being successfully followed in some parts of our state of Maharashtra for the last two years. 3 or more ophthalmologists of each small town, should organise themselves into a group. They should meet periodically for some sort of clinical meeting with if possible, demonstration of interesting cases. Each one should subscribe to a separate journal, year book, or reference book, which can be circulated to all, so that with minimum expense decent reference facility is available to each member. The members can plan as a group attendance to state and All India conferences. In my home town of Amravati we are seven ophthalmologists and we have formed such a group with great advantage. 1 think ophthalmologists of Nasik have also formed such a group. Then groups of 40 or 50 ophthalmologists in an area should form regional societies. We have formed such society the Vidarbha ophthalmic society with its headquarters at Nagpur. Any regional society can organise short workshops with the help of teaching staff of the nearest medical college. If they can afford funds, they can invite experts from any corner of our country. This year our managing committee has constituted a standing committee with Dr. Madan Mohan of Delhi as chairman, who will help and guide any group of our members to organise such courses.
For the problem of our colleagues in railways, managing committee has appointed a standing committee with Dr. D.B. Chandra as Chairman to help these members and make representations to the Government on their behalf. But the services of ophthalmic surgeons already working in these areas are not fully and properly utilised. At many places the hospitals are so poorly equipped that some of our young surgeons use their own personal instruments and equipment to do useful work. Ophthalmic surgeons are being utilised for giving general duties and medico-legal work including conduction of post-mortems. It is a shame. They can be more usefully employed in their own speciality by asking them to tour periodically the primary health centres and conduct mobile clinics in the interior, and also conduct eye clinics for school children in their own towns and surrounding areas. Here I appeal to the members of the public and service organisations to impress upon the Government through the Ministers, M.L.As. and M.Ps. that they must see that the wastage of this specialised talent in routine general duties.
There is one other important field in which our society can do immense service to our members and to the public at large. That is when there is shortage of important drugs. Again our managing committee has asked Dr. D.G. Mody to be the chairman of the standing Committee for drugs. If members bring to the notice of this committee shortage of any drug in any area, the committee will contact the manufacturers and if necessary, the ministry concerned to remedy the same.
We are over 3000 eye specialists in our country. Let each one of us take every opportunity to teach our general practitioners some of the important pit-falls in ophthalmology. We should give talks and demonstrations at the local branches of the Indian Medical Associations. We should read papers at state and All India medical conferences on topics of interest to general practitioners so that many old concepts about cataract, glaucoma, squint and xerophthalmia may be replaced.
Next we come to the state of post-graduate training over which very few past presidents expressed any satisfaction. Every student out for specialization must be made to perform operations of all types and have a practical experience to handle the patients surgically. To make sure the post-graduates must be made to maintain their own operation registers, without completion of which they should not be allowed to appear for the examination. I appeal to our teacher colleagues not to allow post-graduates to pass out of their institutions unless they are comptent ophthalmic surgeons.
Coming to eye banks and corneal grafting procedure once again, our society has time and again pleaded with our Government to pass suitable legislative measures, to enable quick enucleation of eyes from destitutes in our public hospitals. We have even suggessted that it should be compulsory for all deaths in the hospitals to be followed by post-mortem examinations when the eyes can be enucleated as part of that procedure. The Government is run by politicians and politicians depend on popular votes. Why should they antagonise their voters by enacting such an unpopular legislation which will cost them their votes? I suggest a simpler procedure which avoids all these and which has been successfully practiced at some centres in our country. Form a local eye-donation committee with an ophthalmic surgeon as a secretary, with Lions, Rotarians, representatives of other social service organisations, representatives of the press, and a couple of enlightened gentry as members. The civil surgeon also should be included as an ex-officio member. This body will carry out publicity and propaganda and gradually voluntary donations start pouring in. I know of eye banks in Bombay and Gujarat which get more eyes than they can use which they convert into preserved cornea for lamellar grafting. There is a colleague of ours practicing in a small town running his own eye bank. He offered to provide me preserved corneae if I needed them.
A few ophthalimic surgeons specialised in camps had earned name and fame for their speed and dexterity. In all this drama and excitement no body objectively assessed the final result. But after the closure of such camps the local ophthalmic surgeons were busy for the next couple of months treating complications. The next phase was when the social service organisations like the Lions and . Rotarians stepped in with funds and dedicated volunteers. Once again, I stress that we ophthalmologists are 3500 strong and a large number of youngsters have settled in smaller towns. I have talked to many of them and they said that with professors of medical colleges conducting camps in their areas their practice is ultimately reduced to one of medical ophthalmology and refractions. On the one hand our professors wail that they are overworked with routine clinical work and have no time for research or for properly guiding post-graduate students and on the other they are ready to spend days in mofussil eye camps extracting cataracts which can very well be done by local youngsters.
I personally feel that the days of mass eye camps should come to an end. Instead of treating our patients like animals putting them on the floor, grass or husk beds, we should take well equipped mobile eye hospitals into the interior and with the help of local eye surgeons operate upon only 50 to 100 patients at a place. They should be treated on cots with mattresses and a stock of these must be maintained by the local zila parishad or even social service organisations like the Lions clubs, and Rotary Clubs may be asked to participate. I sincerely feel that just as in family planning programmes, ophthalmic surgeons operating at these rural mobile eye clinics should be paid honorarium for their service and sacrifice as so much per patient operated. Even the Lions and Rotarians should seriously consider paying such honoraria to ophthalmic surgeons for their service. As far as possible services of local ophthalmic surgeons should be utilised at such camps.
Finally, I will touch upon one little point before I conclude. That is about the rapidly rising cost of our annual conference. In every state, junior ophthalmic surgeons have bitterly complained to me about this. Let us convert our conference into a mass orientated affair rather than a class orientated one.
Friends, I am afraid I have been on my feet too long. But I had set myself a new task and I wanted to say so much. Let us train our young ophthalmologists properly; let us pay them adequately; let us encourage them generously and the science and art of ophthalmology will take care of itself; and flourish in our country and we will once more attain the pristine glory that we enjoyed in the days of Charak and Sushrut.
Ladies and gentlemen, I dedicate this address to the young ophthalmologists of our country-our hope for the future.
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