TRAINING OF OPHTHALMIC PARAMEDICAL WORK FORCE:
CURRENT CHALLENGES IN BANGLADESH

PROF. RABIUL HUSAIN, FRCS, FCPS.
MANAGING TRUSTEE
CHITTAGONG EYE INFIRMARY AND TRAINING COMPLEX
CHAIRMAN IAPB-SEAR


Bangladesh is one of the developing countries of South East Asia, with an area of 147,000 sq km, inhabited by a population of 140 million. With agro-based economy, 75% of the population living in the rural Areas, with per capita income below US$ 400, 40% of population is below poverty level.

Of the many problems confronted by the nation in the health sector, blindness is one of them. From the recent survey, it is estimated that the prevalence of blindness is 1.52% and amongst the causes Cataract accounts for 80% followed by Refractive Error and Low Vision, Childhood Blindness, Glaucoma and posterior segment diseases.

Realizing the urgent need for service in this sector, a group of social workers formed a voluntary national organization named Bangladesh National Society for the Blind (BNSB) in the year 1973 with the objectives of prevention, cure and rehabilitation of the blind in the country. No sooner, it was revealed that there is an acute shortage of Ophthalmic Human Resources both, doctors and Mid Level Eye care Personnel (MLEP). To overcome this shortage of Ophthalmic doctors, a number of Institutions in the country have undertaken ophthalmic post-graduate training programs leading Diploma and Fellowship, etc.

Unfortunately, no facilities existed for the training of Mid Level Eye care Personnel (MLEP), which is one of the vital components towards delivering Eye care services till 1979, when BNSB took the initiative to develop Ophthalmic Paramedic Training initially as a need oriented Program which, subsequently developed into a structural format to its present state.

It is worth mentioning, the contribution made by Mrs. Brenda Down, a Tutor Sister from England, deputed by the then Royal Commonwealth Society for the Blind, who was not only In-charge of this Training Program for more than a decade, but also gave it a new life and vigor - most significant contribution made by an individual.

Aims of the Course:
  1. To impart knowledge;
  2. To develop skills;
The idea of the course is to provide adequate standard training so that, they are able to function as a safe and informed practitioner of ophthalmic knowledge and skills.

Objectives:

Is to develop proficiency in:
  1. Diagnosis and treatment of common eye diseases;
  2. Care of patients in the OPD, Ward and OT and first hand management of accidents and emergency cases;
  3. Handling patients in various outreach programs, such as; Eye Camps, Screening Camps, School Eye Health Services, Primary Eye Care Program, etc.
  4. Preventive Health and Eye Care;
  5. Health Education and supportive services for the visually handicapped.
Selection / Criteria:

Male and female, young, adults of 18-24 years of age, who have completed 12 years of schooling with Maths, Biology, Physics and Chemistry. Besides, they have to qualify through written and oral examinations. Their aptitude, psychological make-up, motivation and other background are also taken into consideration.

Course Plan:

The duration of training is for a period of two years:

First Year:

Contains five blocks consisting of 340 hours for theoretical and practical classes and 1260 hours of clinical experience. Duration of orientation block is four weeks and other four weeks are preceded by one week of theoretical foundation lectures and assessment at the end. The trainees rotate for about two months in each department and units and ten weeks in various outreach programs.

Course Contents:

1) Impart knowledge on:
  1. Brief general Anatomy and Physiology;
  2. General and Ophthalmic Nursing
  3. Basic Ophthalmology consisting of Ocular Anatomy, Physiology and Pharmacology, Ocular Micro-biology and common Eye diseases.
  4. Optics and Refraction
  5. Common systemic diseases with Ocular Association
  6. Ophthalmic Equipment and Instruments
  7. Record maintenance Patients and medicine, Instruments and Equipments.
2) Develop Skills in:
  1. Inpatient Department -
    • History Taking & Patient Examination
    • Daily Ward Routine
    • Pre-Operative Preparation
    • Administering Medications
    • Dressing
    • Post-Operative Monitoring
  2. Operation Theatre -
    • Aseptic Techniques and Sterilization Procedures
    • Handling Sterilization & Storage of Equipment and Instruments
    • Preparation of Packs for Sterilization
    • Laying out Instrument Trolley
    • Help the Anaesthesiologist
    • Patient Monitoring
  3. Outpatient Department -
    • History Taking patient Examination
    • Visual Acuity Recording
    • Recording Blood Pressure & Urine examination
    • Tonometry
    • Performing Syringing of Lacrimal passage
    • Removing External Foreign Bodies & Stitches
    • Performing Sub-Conjunctival & Sub-tenon Injection
    • Lensometry
    • Schirmer Test
    • Counselling
  4. Outreach Programs -
    • Participate in:
    • Mobile Eye Camp / Screening Camp
    • School Eye Health Service
    • Primary Eye Care Clinic
Second Year :

During the second year the Trainees get intensive task oriented training in the following specialized areas:

Refraction, Glaucoma, Cornea, Contact Lens and Low Vision, Paediatric and Orthoptic Clinics, Vitreo-Retina Clinic including fluorescence Angiography and Laser, accident and emergency, Eye Banking, Counselling and Management.
Besides, they actively participate in all areas in the Operation Theatre and Central Sterilization and Supply Department (CSSD). They are a team member in the various out reach programs.

FACULTY:

The faculty initially, consisted of full time and part time tutors from both home and abroad, a number of skilled trained Paramedics, who have demonstrated, persistent, academic excellence, dedicated service and eager to learn and contribute are selected to undergo overseas training in specialized areas and discipline. They are now, running the program independently and is the backbone of the Institution. To keep them abreast with the modern developments, there is a Continuous Medical Education program (CME). On average 15-20 students are admitted in a batch. In this program a total number of 336 Paramedics have successfully completed their two years certified course.

This is to mention that, some of the neighbouring countries in the Region have also taken advantage of this Training Program.

A number of short term specialized training courses for the Paramedics in different disciplines such as, Refraction and Low Vision, Ocular Microbiology, OT and CSSD, Glaucoma, Eye Banking, Retina and counselling are in existence in this Multidisciplinary tertiary care Eye Infirmary and Training Complex. Till date 146 trainees have undertaken these short-term courses in various disciplines. All these MLEP are now engaged in the delivery of Eye Care services across the country.

If we consider the optimal ratio of doctor and MLEP is 1:4, we have to quadruple our output of MLEP by the year 2010. In order to maintain the ratio and to achieve this, a number of Institutions should take up this MLEP training as a crash program. This can only lead us towards achieving the target of Vision 2020 The Right to Sight i.e., to contain the number of avoidable blindness by Year 2020.