Collaborating is key: Delivering eye care in COVID lockdown

May 2020

The COVID-19 lockdown that came after WHO declared it a pandemic has crippled every regular activity in the world. In Nepal, the lockdown did allow for essential services but for the essential services to continue even, a certain supply chain needs to be maintained. As the lockdown continued and time passed by, there were limited avenues to access even extremely essential items in the Nepali markets. The far-reaching impact of the lockdown started arising when hospitals started running out of indispensable items such as masks, sanitizers, gloves, and even medicines. The growing scarcity of these essentials in the local market led to black marketing. A dearth of PPE in the eye hospitals left front level service providers vulnerable to the potent infection.

Nepal Netra Jyoti Sangh (National Society for Comprehensive Eye Care) works with 18 eye hospitals 93 eye care centers and 42 district branches spread across the country. Although certain eye care centers and district branches could not continue to function, the hospitals remained open for emergency services as per government directives. Nepal Netra Jyoti Sangh (NNJS) immediately jumped to action the moment they were informed by its member hospitals that they were unable to procure protective kits to continue delivering emergency services. Collaboration and advocacy became NNJS’s tools to ensure they could help these hospitals.

Joining hands with the government

NNJS and local government representatives meeting to decide on CoVID-19 preparedness

NNJS began talks with federal, provincial, and local governments to provide essentials, PPE and medicines to support its hospitals. This entailed the NNJS central office to coordinate with Department of Health Services and arrange to send remarkable quantity of masks, sanitizers, PPE, and gloves for its hospitals.

Managing safety protocols to provide eye care

While the emergency cases continue to pour into the hospitals, NNJS began strategizing to ensure all hospitals follow certain common guidelines to ensure patient and staff safety. To begin with, rotational shifts were put in place for all hospital staff to adhere to the social distancing norms. The NNJS Central office, keeping the WHO safety measures in mind, developed Standard Operating Procedures (SOPs) along with creating COVID-19 committees at its partner hospitals to monitor and track the implementation of the SOPs and guidelines with regular follow-ups, learnings and way forward to address emergency services. Project Managers of Orbis REACH teams are part of these committees.

Training and orientation committees to train staff on the WHO and NNJS safety protocols while working with the patients have also been put in place. Hand hygiene and sanitation measures for staff and patients have also been made.

The Challenge

The pandemic has created unforeseen challenges. Although Orbis’s REACH program has come to a temporary halt, its partners have been working in various capacities to ensure that the emergency cases during COVID are catered to. One of the challenges that NNJS-Orbis partners have faced is access to the hospitals. Whether it is staff or patients, the ongoing restrictions have created roadblocks in accessing and delivering services.

An NNJS-Orbis REACH partner hospital, for instance, RM Kedia Eye Hospital (RMKEH), initially faced issues to access PPE kits which made it difficult for staff, ophthalmologists and optometrists to provide eye care to the patients who were arriving at the hospital. “It is difficult to send back patients who take pains to come to the hospital to receive treatment during such trying times. When we did not have PPE kits, the doctor decided to use all protective tools that were at his disposal at the hospital which was the use of an X-ray film to reduce patient contact to equipment during slit lamp examination, use of surgical gown, gloves and other items to continue serving patients in limited capacity,” explained Prakash Kumar Verma, Project Manager of Orbis-REACH at RMKEH.

It was only after NNJS, with its collaboration with the government, received permission to transport essential medicines and PPE kits to the hospital that it was able to function and attend to patients with its full capacity.

At present, the footfall of the patients in each of Orbis-NNJS partner hospitals is in the range of 20-40 per day. Abhishek Roshan, Project Manager, Orbis REACH at Sagarmatha Chaudhury Eye Hospital in Lahan, Nepal said, “There are challenges in this sort of scenario. One of them being the availability to tools and medicines to serve the population, especially, the emergency patient cases. We are receiving support from NNJS. What is time consuming is the transportation of the essential items to the hospital.” The partner hospital based in Lahan is approximately over 250 kilometres away from Kathmandu. NNJS which is based in Kathmandu has been providing PPE kits and essential medicines to its partners by road.

Sudhir Thakur, another REACH Project Manager from Biratnagar Eye Hospital said, “It would definitely not have been possible to continue working smoothly if it were not for the initiative by NNJS to transport essentials to us on time.”

How is the NNJS support helping hospitals serve patients?

Ankit’s parents felt relieved when they were able to get their child’s eye injury (hurt with a cricket ball while playing) treated on time. Ankit’s parents feared that they would not be able to reach the hospital given the current COVID-19 situation as most transport systems were unavailable. They had to go through several police check posts before they could get to the hospital and were worried, they would be turned away by the police authorities but luckily, they could travel to the hospital.

The above story is from Biratnagar Eye Hospital (BEH), an Orbis REACH partner which had been delivering eye care services to schools through the Orbis REACH program in Sunsari for the past two years. Notably, during the COVID-19 crisis, Biratnagar Eye Hospital is the only facility available that can provide emergency services in Province 1 of Nepal.

Sukraj hurt himself with a sharp knife and his parents were extremely worried about his vision. But when they reached the hospital, they felt reassured that Sukraj would be fine after surgery.

MEH is an Orbis partner hospital which has been delivering eye care services to schools through the Orbis REACH program in Jhapa for the past two years. During the COVID-19 situation, the hospital has also been able to provide a 100-bed hospital wing which serves as a quarantine unit.

Working together while apart is the way out

In such trying times, hospitals need crucial support to continue serving the community. Support like the one provided by NNJS is crucial and as time passes by these hospitals would need further assistance. Orbis stands with NNJS and its implementing partners to continue the difficult task of providing eye care to the community that needs it most.