Orbis partner's COVID response: Dr. Saini explains hospital protocols

Due to the national lockdown, the Siliguri Greater Lions Eye Hospital, including all eye hospitals in the country could only provide emergency services for most of April and May this year. How do you think it affected the functioning of eye hospital?

With the Unlocking phase of lockdown in the country, eye hospitals are slowly getting back to the usual modes of working with certain ‘obvious’ changes and social distancing norms, gearing up to face the after-effects of lockdown.

We recently had a chance to interact with Dr. Rajesh Saini, CEO, Siliguri Greater Lions Eye Hospital to understand the first-hand experience of the Orbis partner hospital in responding to the crisis and formulating the approaches ad action plan. Here is a glimpse of the discussion.

With the pandemic and national lockdown, the number of patients per day drastically reduced to 150, which is less than 50% of the patients prior to the pandemic. The last few months have been extremely challenging as we have been facing dual challenge of financial sustainability and the pandemic itself. Nonetheless, we have ensured that we retain all our staff and serve the patients with same affection, expertise and care. Without denying anyone treatment and keeping hospital services accessible to those in need, we continued to provide Emergency Eye Care services and Online OPD. Patients who were unable to reach to the hospital or who couldn’t afford the services, were provided with free Online OPD consultation services.

We also leveraged this time, to re-think on our systemic approach to safeguard our staff and patients. From how we look at OPD and basic infrastructure changes to behavioural change and safe screening measures; the hospital adopted numerous measures in its fight against COVID-19. The hospital has developed one of the biggest Central Sterilization unit among eye hospitals in North Bengal to sterilize phaco handpiece, surgical instruments, OT linen, and tubing.

We have never really used technology and telemedicine, as extensively as now. COVID-19 precaution measures including social distancing and use of sanitizers and hand washing are extensively promoted and incorporated in hospital functioning. The definitions of the must haves and to-do-lists are rapidly evolving.

Going forward, we are also leveraging our Vision Centers to reach out to more patients.

It is interesting you touched upon Vision Centres as a possible approach to reach out to those in need of eye care services. What are your observations on the role of VC, especially while we deal with the pandemic?

With the temporary shutdown of public transport, Vision Centres (VC) were one of the effective means to reach to patients who are stuck in the remote rural areas. During the lockdown, Greater Lions Eye Hospital launched free transportation and food services in ambulance to help people reach our hospital. To reduce the financial burden on individuals who couldn’t afford a cataract surgery, we charged a nominal amount of INR 2500 from patients and rest was borne by the hospital.

Yet, we soon realized the cost effectiveness of providing eyecare services lies with transitioning the primary screening at VCs, followed by visit to the base hospital wherever necessary. The fresh set of mobility guidelines and reduced restrictions declared by the Government of India from 1 June, is particularly helping the hospital to increase the patient flow and, resume the OPD & IPD services.

The Greater Lions Eye Hospital also worked with Orbis in transforming the Vision Centers to Green Vision Centers. How would you say it has helped during the current scenario?

Yes, and we are absolutely delighted to have partnered with Orbis India in converting 4 VCs of Siliguri Greater Lions Eye Hospital located in Darjeeling and Jalpaiguri districts of West Bengal into Green Vision Centers (GVCs). The GVCs were launched in April 2019 to provide reliable energy for delivering uninterrupted primary eye care services supported by a technology-enabled data management system for VCs.

One of the key challenges observed in the functioning of these VCs was the lack of a reliable energy source and access to quality data. To address these gaps, Orbis India installed renewable solar energy system and digital data management software (ICOM) in the 4 GVCs

The technical support provided through ICOM, particularly, came in handy in following up with referred patients and ensuring minimum dropouts. Times like COVID, particularly help you understand the significance of technology. With ICOM, we are not just managing the data effectively and transparently, we are also monitoring the performance of all GVCs from the base hospital.

Moreover, with reliable energy supply, patients are sure of getting required services at GVCs at any given point of time and the green initiative has been successful in building the trust among community. Through this sustainable approach, the 4 GVCs supported by Orbis have provided primary eye care services to 783 patients from April-June 2020.

Number of patients treated at the Green Vision Centres (April- June 2020)

Pramila Pal, a 55-year-old from Shibmandir in West Bengal got her cataract first diagnosed 6 years back. The then consulted doctor had said it was not necessary to undergo surgery as it was in a very nascent stage. With time, Pramila started ignoring her cataract and continued to live with it.

The knocking realization of the impact of cataract on her vision came in when Pramila couldn’t see her new born grandchild, beyond 6 feet! She visited many Ophthalmic Centres, before coming to the ShibMandir Green Vision Center. At the centre Bishwaroop, one of the Vision Technicians trained by Orbis thoroughly screened her. She was diagnosed with mature condition of Cataract. Pramila says while other ophthalmic centres kept her in dark, and installed fear about her eye condition; she felt relieved speaking to the Vision Technician at the Green Vision Centre with his detailed explanation of Cataract, her eye condition and the ease of surgery with which Cataract can be removed. She felt relieved and believed she could have her vision back.

Pramila was referred to the hospital from the Vision Centre but was a little sceptical due to COVID-19 spread. After visiting the hospital, and observing the safety measures her perception changed and underwent the Cataract surgery on June 20^th, 2020. During her first visit at the hospital she said that she was overjoyed when she could see her grand child properly for the first time. She loves to spend her time watching her grandchild play.

Would you like to highlight some of the initiatives undertaken by the hospital to respond to COVID-19?

In our effort to contribute towards mitigating the effects of COVID-19 crisis, Greater Lions Eye Hospitals was one of the first institutions in the region to offer the Government on converting one of its hospitals into Isolation Center. Siliguri Greater Lions Shri Vidya Sagar Oswal Eye Hospital became one of the first well equipped regional Isolation Centre, created with support from the State Government.

Over the month of April and May, more than 270 patients have used the isolation facility with 120+ beds. The hospital infrastructure was taken over by the Government of West Bengal on April 1st, 2020 and is till date under Government’s direct jurisdiction.

With support of District Administration, we also provided food supplies to more then 12780+ bags of dry ration to families of migrant workers, daily wagers through the Jan Aahar (Public Food) project, reaching to more than 40,000 people in the region.

During the distribution of the Food Ration, the hospital experienced that there is an ardent need of basic hygiene awareness among the local population living in rural and sub-urban regions. The houses built in chocked close quarters and poor sanitation facilities, narrates the account of poor hygienic condition in the community. The hospital, with support from various scores, distributed hygiene kits comprising of Hand Sanitizer, 2 Pairs of Gloves, Bleaching Power, 4 Face Masks, 2 soaps to each family. The hospital took these kits to more than 12131 families and provided them with necessary training before handing over the hygiene kits.

How do you plan the year ahead and what would you like to suggest to the fellow eye hospitals?

As the Government of India continues to restrict community gatherings, organizing outreach activities pose a challenge. We are now focusing on reaching out to communities through Vision Centres/ GVCs for sensitizing beneficiaries and organizing door-to-door screening activities. We have mobilized community health workers and closely working with voluntary formal and informal health workers. The hospital also runs a comprehensive rural youth optician training programme empowering them with basic eye screening and refraction. These youth are now being empaneled with the Vision Centres to create awareness on basic hygiene, spread the word on preventive measures around COVID-19 and undertake basic eye screening for early diagnosis/ referral to the hospital.

I believe that the pandemic has brought about unique opportunity to explore innovative approaches and understand our stakeholders better. The behaviour of patients is rapidly changing, and we need to learn and catch up with them. For example, we recently observed that along with the demand, the compliance rate of spectacles has increased from 60-65% to 85-100%! We are yet to study the reason, but our initial analysis tells us that one of the key reasons is that people think it will reduce the frequency of touching the eyes just by wearing spectacles. Teleconsultation has been widely accepted by the patients now, compared to anytime before. Lastly, I can only say that things are changing rapidly and we cannot have a fixed plan. Be flexible, be adaptive to change.