Persistent passion to treat patients

June 2020

Here’s how one of the cities with most COVID-19 cases in Nepal is continuing its mission

As the number of Covid-19 cases rise in Nepal, there are several issues that eye hospitals are grappling with. Orbis’s partner, RM Kedia Eye Hospital, has been undertaking various emergency cases since the lockdown and trying to make sure that no patient returns without treatment when it is needed most.

Given the dense population, it has been reported that the COVID-19 cases are highest in Birgunj, a city in Nepal. But that did not deter Orbis partner, RM Kedia Eye Hospital to continue its mission.

“We didn’t have any protective covers for slit lamp examinations early on during the lockdown so our doctors had to use an X-ray film to be able to do slit lamp examinations. Until the PPE kits had arrived from Kathmandu, the doctors had been working with whatever was available at their disposal,” said the Orbis-REACH Project Head, Mr. Prakash Kumar Verma at RM Kedia Eye Hospital (RMKEH). With the use of surgical gowns, the doctors were able to undertake preliminary eye exams for emergency patients.

Orbis’s association with RM Kedia Eye Hospital dates back to 2010. Most recently, Orbis joined hands with the partner in Birgunj to implement the Refractive Error Among Children (REACH) project in Parsa district of Nepal among three other locations.

Overcoming the hurdles one step at a time

Although the Orbis-REACH implementing partner had to recently take the difficult decision of halting outreach activities which included school screenings due to the government announced lockdown and the growing number of COVID-19 cases, RMKEH still remained the lone hospital that was providing emergency care services to the community.

Below: (Left to right) Temperature check at RMKEH entry gate, use of open space to interact with patients and manning patient registration with necessary precaution

RMKEH has lower number of staff in the facility due to the lockdown. The drastic reduction in staff and ophthalmic personnel as a result of the lockdown and movement restrictions evidently affected the hospital capacity to attend to patients. Patient safety and medical treatment was difficult to ensure owing to the lack of medicines and protective gear during the initial phase of the lockdown. But when help arrived through Nepal Netra Jyoti Sangh’s collaboration with the government to transport and supply these essentials to RMKEH, the hospital went on to treat the patients who had begun to pour in.

RMKEH staff following standard protocol for patients entering the facility

A range of pediatric emergency cases

Over the two months of lockdown, RMKEH helped take in child patients in need of emergency eye care. Whether it was a cricket ball injury or redness in eye, the pediatric eye care facility’s doors were open to treat every child patient at the earliest.

RMKEH staff training and demonstration session

With almost 10 pediatric emergency cases in a week showing up at the hospital, the staff and doctors were ready to attend to them and ensure that they went home content. Apart from training its staff about the precautionary measures, the hospital has also put up COVID-19 awareness posters and banners within its facility for the incoming patients. The hospital staff have also been asked to verbally provide some precautionary awareness tips to the patients.

Absence of transport, presence of care

Irshad’s parents had to wait one week to be able to take him to RM Kedia Eye Hospital due to the COVID lockdown that limited movement and restricted public transportation. Irshad, a four-year-old, had ended up injuring his right eye while playing with soil. As days progressed the injury led to redness in his eye. When his parents were finally able to take him to the hospital, it was ascertained that Irshad suffered from a hemorrhage in his right eye. The doctor at the Orbis partner hospital provided the child with a medicine prescription and recommended a cold compression.

The one-week wait bothered Irshad’s parents the most. Since they were not aware of the repercussions of their child’s visibly red eye, they dreaded that Irshad’s eye condition would worsen. In the absence of transport, even though they were aware of RM Kedia Eye Hospital, they knew it was far away (30 kilometres or over 18 miles), so initially they looked for options close by with no luck.

But their inhibition about their child’s eye problem was put to rest once Irshad received proper diagnosis and care at RMKEH. Had he not received the care at RMKEH or had they not been able to travel the distance or find transport, Irshad’s father said, he would have to eventually give in to going to a local pharmacy to get over-the-counter medicines and looked at it as a last resort. However, having reached the Orbis partner hospital despite the COVID lockdown, Irshad’s father felt relieved and happy that his young child could receive treatment even during such difficult times!

Overcoming COVID lockdown challenges

It took Nitesh’s parents 15 days to get to RMKEH in Birgunj given the lockdown transport restrictions and the fact that cases of the virus were on the rise. Nitesh had a scar in his eye, the reason for which his parents could not explain. The doctors ascertained that he had an eye injury but his parents were not aware as to when and how their child had been injured. In 15 days, Nitesh had a cloudy lens in his left eye. In some cases, a surgery is recommended but lucky for Nitesh, he was prescribed medicines which made his parents extremely happy. Initially, when they could not find eye care facilities around them, they considered accessing homeopathy but luckily they found RMKEH functioning and were happy to see their child being treated at the right place even if not at the earliest

RMKEH has been associated with Orbis since its National Program for Control of Childhood Blindness in Nepal in 2010. Through the program Orbis helped support the hospital in capacity building to deliver pediatric eye care services. Part of the program was to strengthen primary eye care centers to deliver services to children among the underserved population. One of the key developments of the program is that RMKEH was able establish a pediatric eye care facility with Orbis support that runs till date and provides quality pediatric eye care services. Most recently, Orbis had undertaken the REACH program with RMKEH as one its three implementing partners in Nepal under Nepal Netra Jyoti Sangh.