From a School Screening Team to Frontline Aide

An unexpected situation had arisen when news came of the COVID-19 lockdown in India. Most Orbis partner eye hospitals had to pause their community eye care initiatives as schools and large-scale gatherings were prohibited. Limited as their capacities were, it did not deter them from serving the community.

VMA Netra Niramay Niketan (VMANNN), an Orbis partner who has been implementing the Refractive Error Among Children (REACH) project in West Bengal since 2016 found itself having limited ability to continue their journey in eliminating avoidable blindness among school children. Orbis’s REACH program, supported by Qatar Fund for Development (QFFD) through the Qatar Creating Vision (QCV) initiative, is spread across the country and VMANNN is one of the partners who had been implementing the project.

Orbis’s partner hospitals had developed QCV-REACH teams to conduct screenings and evaluations among school children in various districts. Young promising Vision Technicians, Optometrist, Counsellors and Opticians led by an ophthalmologist are part of the QCV-REACH team at VMANNN. Due to the COVID-19 lockdown, however, some of the team members were unable to travel back to the hospital given the complicated logistics and restrictions. But the remaining staff of the QCV-REACH team, despite their inability to reach children at schools, decided to take on a new role.

“When the lockdown was declared, we realized that we have to work with reduced number of staff so what would we do?” said Dr. Asim Sil, Medical Director, VMANNN. He continued that when the first nationwide lockdown was introduced in March, they had to take certain unforeseen steps, “There were so many people staying at the hospital’s hostel and we needed to reduce the crowd which meant we had to let go of a lot of people.” There were reduced staff members, but emergency cases continued to arise and present at the hospital. Sometimes it was adults with eye conditions that could not be overlooked and at other times it was children with eye injuries that needed immediate intervention. As time passed by with further extension of the lockdown, more cases started pouring in. It meant that the hospital had to be ready to attend to these cases even without its optimal strength

“That’s exactly when we discovered their (the QCV-REACH team’s) ability during this period (low staff numbers). Really, they were so instrumental in running the show; they have worked in various capacities- to register patients, refraction of patients, screened them, assisted the doctors to attend to them; they’ve done OCT and ultrasonography. Actually, it was not part of the REACH project to teach them ultrasonography, OCT and all the other investigation skills but out of their own interest, while they are at the hospital, unable to continue school screening, they learned the skills and applied them in no time. That has become so useful during this time,” said Dr. Sil and continued, “During this crisis period, I don’t know what we would have done without these (the QCV-REACH team) people.” On an average, there are 30 to 35 cases that the hospital manages per day with its limited staff. Due to unavailability of solo practitioners, many patients have been forced to travel long distances to be able to get to VMANNN and access services. Some patients had to travel for three hours even to reach the facility due to closure of the clinics in their vicinity.

Apart from their rotational shifts at the hospital, on days when the QCV-REACH team members were not on hospital duty, they went on to serve the community through the hospital’s initiative to provide food relief.

The hospital took on the task of providing food packets (pulses, rice, potatoes, soya nuggets and cooking oil) as well as a sanitation pack which included two soap cakes. This too needed a lot of effort and the QCV-REACH team members jumped in to help. The hospital decided that they would reach out to the population that needed it most. They worked with the local police personnel to identify and prioritize Persons with Disabilities (PWD), widows and daily wage earners for delivery of food relief packets.

Thanks to technology that connects each one of us through basic platforms like Whatsapp and mere phone calls, the doctors at the Orbis partner hospital can provide consultation to patients without them visiting the facility.

Dr. Subhra Sil, ophthalmologist and project head of the QCV-REACH team at VMANNN has been working tirelessly not only to address the emergency cases that arrive at the hospital but also through teleconsultation. “Some of my old post-operative patients have been wanting to come to the hospital for follow-up with questions such as whether they have to continue their drops or any other medication. Now they can’t come to the hospital, so they have been asking through phone calls and by sending images and I’m responding to them accordingly. Patients consult for redness, watering, viral eye conditions, conjunctivitis or ask when they can come to the hospital to get their glasses or get a glass prescription even,” explained Dr. Subhra Sil. “We feel teleconsultation is something that is very much required (during such times) and for vision centers it’s a must! If not every day, teleconsultation can be twice a week.”

In fact, the husband-wife duo of Dr. Asim Sil and Dr. Subhra Sil, have been providing teleconsultation services to patients free of cost. “I’m using Whatsapp, mostly, for our Vision Center patients. Our Vision Center is not functioning but our Vision Technicians are there and patients are reporting to them. We have them send us pictures of the patients’ eye condition. Either they are sending the pictures to my phone or to Subhra’s phone and we’re immediately responding.” The doctors have been ascertaining if the cases can be attended to remotely and prescribing medication along with eye drops for various cases and asking their patients to report to them after a few days with the outcome by sending another image of the affected eye. They check if the condition has improved which helps them keep the patients from arriving at the hospital. “This has helped many patients,” said Dr. Sil. In a week, almost five to six cases are undertaken by the doctors through phone calls and Whatsapp.

Dr. Subhra Sil and Dr. Asim Sil have been instrumental in treating complicated cases that have arisen during the COVID-19 lockdown. Dr Asim Sil operated on a two-month old baby who had a foreign body (some particle) in his eye. Dr. Subhra Sil, on the other hand, undertook the task of removing a piece of wood from a two-year-old child’s eye. “We wondered if we cannot remove the object where would we send the child?” said Dr. Asim Sil. “We undertook the two-year-old’s case by using local anesthetic drops. Otherwise the child would have needed general anesthesia and none of the hospitals are administering it right now. It was difficult to examine her eye. The removal of the piece of stick will immediately help control the infection in the child’s eye,” said Dr. Subhra Sil after having successfully removed the stick.

Orbis stands with its Orbis Volunteer Faculty and the QCV-REACH team and its partner, VMANNN, in their mission to address patients even during such trying times.

VMANNN has been associated with Orbis since 2007 when we collectively undertook a Behaviour Change Communication for Diabetic Retinopathy project, “Save Your Sight” (August 2007 – December 2011). Subsequently, this partnership helped establish a dedicated Children’s Eye Center in the base hospital under the West Bengal Childhood Blindness Prevention Project (January 2010 – January 2014). Our most recent association with them involves the Refractive Error Among Children (REACH) project which we began in 2016 through which the partner hospital conducted a massive 300,000 screenings in three years. In addition, Dr. Asim Sil, Medical Director of VMANNN is an Orbis Volunteer Faculty. He is also a resource person supporting Orbis India in conducting research, especially population-based baseline surveys at partner locations.