Preparing for the Next Normal in Eye Care

As India goes through intermittent lockdowns or lockdown-like curbs to contain the spread of coronavirus, the social and economic impact, particularly for the marginalized community is widespread. While extensive efforts have been taken to create awareness on COVID safety measures, but there are other hidden, seemingly avoidable health issues that can lead to irreparable damages if neglected. One such issue that needs special mention is ocular health.

People facing eye health issues are readily ignoring the ominous symptoms of red-eye, blurred vision, headaches, and are reluctant to visit hospital. Lockdowns, fear of second and third wave of COVID, financial challenges and lack of awareness are some of the barriers preventing people from seeking timely eye health service. The pitfall is that patients are landing up with irreversible vision loss and increased probability of complicated surgeries and procedures.

A large part of our work in India is focused on prevention and treatment of avoidable childhood blindness. With COVID-19 and shutdown of schools, Orbis, along with its partner hospitals in India, is reimagining ways to deliver eye care for children, who are now confined to their home.

One such initiative is being implemented in partnership with Akhand Jyoti Eye Hospital (AJEH), where we have been continuously improvising the program strategy to continue our work, post COVID-19.

At the onset of COVID-19, when the Government declared nation-wide lockdown, AJEH had suspended OPD services and community outreach activities, and was managing emergency services with minimal staff. In due course, Akhand Jyoti made necessary infrastructural changes, and developed COVID safety protocols and standard operating procedures in the new normal.

The week-long Orbis Cybersight webinar series on ‘Unlocking Possibilities Beyond Lockdown’, was particularly helpful in helping the team at Akhand Jyoti and hundreds of other eye care professionals from India to develop a futuristic roadmap on managing service delivery post lockdown.

Later, as we progressed towards unlocking phases in the country, Akhand Jyoti resumed its OPD, IPD services and organizing eye camps towards the end of 2020. Optometrists and patient counsellors, trained by Orbis support played a significant role in ensuring that the patients reach the base hospital, post initial screening done in schools and Anganwadis. Chhavi Kumari, Optometrist, pediatric counsellor and outreach coordinator alone followed-up with 129 children who required surgical intervention.

While children with eye care needs had started visiting Akhand Jyoti, the team felt it wasn’t enough. There were considerable number of people who had their reservations in visiting the hospital in the midst of rising COVID cases. This was an onset to series of discussion between Orbis team in India and AJEH team, on how the eye care services can be made more accessible and ways of delivering care in time. The team unanimously agreed on piloting door to door screening in Narayanpur village of Garkha block. This was followed by detailed planning of activities and identification of team members who can be part of the pilot intervention.

A team of three staff members, including Senior Optometrist, Mobiliser and Counsellor were designated for doing the screening activity in Narayanpur village.

First day of the screening was challenging, as the community wasn’t prepared to welcome the three visitors from hospital. The team then engaged a local community influencer, to seek support in interacting with the villagers and organize the screening activities. Soon, the hospital team started coordinating with the ward member of each ward in Narayanpur for eye screening activities.

AJEH team organized screening activities every day, preferably at the ward member’s house. The mobilizer from project team would visit every household in particular ward and share details of the screening conducted at the fixed location. The senior optometrists conduct the primary screening, followed by torch light examination and direct ophthalmoscopy. Children with surgical eye conditions are then referred to the base hospital and those with refractive error are called for secondary examination in the vision van.

Vison Van or Drishti Saathi, equipped with state-of-the-art ophthalmic equipment, staffed with professional qualified optometrists, opticians, among others is exclusively designed to reach out to children in rural and underserved areas, where eye care services are scarce. It is an innovative mobile primary screening and treatment facility, which is equipped to offer services such as visual acuity assessment, refraction, slit lamp examination, tonometry, fundus examination and on-the-spot delivery of spectacles. Orbis leveraged Vision Van to conduct secondary examination of children, to ensure easy access of quality eye care services for the community.

During one of our recent screening visits to Narayanpur village, we were delighted to meet Khushi from nearby Moharapur village. Rani, who is Khushi’s friend from Narayanpur had convinced her to come and visit the eye screening organized at the ward member’s house. Rani had known about her friend’s complain of usual headaches and watering in eyes.

“I was excited to step out of the village and have some fun conversations with Rani. Moving out and meeting friends isn’t one of the usual practices here in our village, especially after the school got shut post COVID-19”, smiled Khushi.

While Khushi had been dealing with frequent headaches, blurred vision and watering in eyes for over six months, visiting a hospital or a primary vision center wasn’t a choice for her. Phuldevi, her mother explains, “We cannot step out or meet a doctor without the presence of a male family member, until absolutely necessary”. In the meanwhile, Phuldevi was taking care of her daughter at home, giving the best home remedies possible for Khushi. “I had also spoken to her (Khushi’s) father and he suggested that I massage her head with a traditional oil massage therapy. He would often use the same oil in case of a headache”, she said.

Khushi’s father has been living in Delhi for over seven years now, with Khushi and her mother living in the village, taking care of their one-acre piece of land. “Her father is a truck driver and keeps travelling for months at times. It feels much safer to be in our own village, rather than staying without Khushi’s father in Delhi. Moreover, cost of her education and daily expenses are far less here compared to the city”, says Phuldevi.

The oil didn’t improve Khushi’s vision though. With time, Phuldevi noticed a change in Khushi’s interaction with friends and family. During the primary screening, Khushi told us that she would rather spend her time sleeping in order to mitigate the persistent headache, followed by blurred vision after 2-3 hours of continuous studies.

After the primary screening, Ashutosh, a counsellor present on that day finally explained the correct reason of her headache - uncorrected refractive error. He also informed Khushi on the schedule of her secondary examination in the vision van. The counsellors have been playing an important role in educating the guardian/parent of the referred children about the child’s eye condition and removing necessary myths around eye conditions. The tele-calling team at AJEH also informed Puhldevi on the schedule of the Vision Van visit to help facilitate secondary examination of Khushi’s eyes.

Yet, on the day of confirmatory camp Khushi did not turn up to the vision van. When the project manager, Abhishek noticed Khushi’s absence, he spoke to ward member and visited her place. During the visit, Abhishek realized that Khushi’s grandmother was concerned of Khushi’s marriage prospects and had therefore refused her for detailed examination or on wearing spectacles. Upon counselling by Abhishek, backed by Khushi’s persuasion, convinced her grandmother for secondary examination.

Khushi on the contrary is looking forward to get a pair of glasses, so she could get back to studies without worrying about the headache and blurred vision “I want to join police academy after my studies. In my village, no girl is allowed to study post 10th or 12th standard and are forced to get married. I want to show my relatives and community that girls can also work and earn a living. I want to change the stereotypical image of a girl as a ‘bahu’ (bride), meant to manage household chores and kids. I am much more than that”. Khushi’s dreams are supported by her parents and are comfortable with her wearing spectacles.

After five days of initial screening about which Rani had informed, Khushi was finally looking at a pool of spectacle frames placed in the Vision Van. Choosing the right frame for her, she mumbled “Black is my favourite color”, while Rani picked up a frame with the blue frames which matched Khushi’s dress.

Since 2016, Orbis has been working with Akhand Jyoti to strengthen pediatric eye care services in the region. The initial two years of engagement with AJEH was focused on improving quality management system and building capacity of eye health professionals.

Since 2018, the project is currently focused on screening school children and those in Anganwadis across Parsa, Dariyapur, Amnour, Dighwara, Garkha and Maker blocks of Saran District in Bihar.