

Vision center activities

S. Sheela Devi
Former Research Project Manager
Laico

Activities

Active screening services
1. Refractive error
  1. Check for distance vision and if vision is <= 6/12 in either eye, do pin hole examination. If the vision improves do refraction. Put the patient on the web cam and discuss with the doctor about his prescription. If doctor advice for prescription, counsel the patients for spectacle usage and get the order. Inform the patient that the message will be given to him as soon as the spectacle is ready.
  2. If the vision is not improving refer the person to the BH.
  3. Check for near vision and if interested to get spectacles, put the patient on the web cam and discuss with the doctor about his prescription. If doctor advice for prescription, counsel the patients for spectacle usage and get the order. Inform the patient that the message will be given to him as soon as the spectacle is ready.
2. Cataract, squint & other external eye diseases
  1. Estimate visual acuity and do anterior segment examination and put them on the web cam and if any first aid advised by the doctor, do the first aid and refer to the BH.
First Aid services
1. Conjunctivitis
  1. Put the patient on the web cam and get the doctor advice. As per the instructions by the doctor do first aid and refer the patient to the BH. Advice the patient for frequent eye washes with the clean water.
2. Corneal abrasion & corneal ulcer
  1. Estimate vision & do fluorescent staining. Put the patient on the web cam and as per the advice by the doctor apply antibiotics and refer the patient to the BH.
3. Trauma
  1. In case of penetrating injury, put patch on the injured eye and refer the patient immediately to the BH.
  2. In case of blunt injury, check visual acuity and refer the patient to the BH.
  3. In case of chemical injury wash with water & refer immediately to the BH.
4. Foreign bodies
  1. If conjunctival put the patient on the web cam and get the doctor advice to remove the foreign body. Use sterile bud and remove it and put the patient again on the web cam and as per the instructions apply antibiotic and refer accordingly.
  2. Any other condition put them on the web cam as per the advice apply antibiotic and refer to the BH.
Ophthalmogist services:
1. Once 30 spectacle orders have been obtained and the glasses have been ready, an ophthalmologist visit could be arranged for half day at the vision center.
2. During his visit he could examine the patients thoroughly using slit lamp, indirect ophthalmoscope and IOP also be measured. If necessary the doctor can dilate the patient for further examination.
3. After the examination he could deliver the spectacles to the patients.
Referral services:
1. Issue referral card to all the patients referred to the BH with the attachment giving details on the vision examination completed by the vision assistant.
2. Maintain separate list of cases referred to the BH.
3. Send the referral list to the hospital by email on a daily basis for their reference.
4. Also send a copy to the volunteers concerned to motivate the individuals to visit to the BH for detailed examination.
Health Education:
1. Posters and pamphlets will be displayed at the vision center.
2. Individual and group counseling and education will be given to all the persons visiting to the center.
3. Emphasis will be given on eye health promotion and prevention issues like vitamin A deficiency, injuries, hygiene etc.
4. Video on general health education and eye health promotion will be showed at the vision centre. (Future)
Follow up & compliance:
1. Follow up details on the patients visited to the vision center will be obtained from the base hospital and will be maintained separately.
2. Also data on medical compliance monitored by the volunteers will also be maintained at the vision center.
Population based surveillance system:
1. Village level data on demographic and eye care utilization pattern will be entered and updated as and when it has been collected.
2. All necessary information obtained will also be plotted in GIS for further planning and implementation
Training programmes:
1. First TOT programs will be conducted at the vision center.
2. Subsequent TOT / volunteer training program will be done at the villages.
3. Community worker will be the responsible for all the training programs and if necessary vision center team could also be involved for training and lecturers will be also be handled by the same team.
4. Any awareness or education programmes to other NGO staff will be organized at NGOs place during their regular staff meetings.
School screening programme:
1. Aravind hospital, Theni will be organizing school screening programs and the community worker will support the hospital team for logistics arrangements.
2. School screening data will be obtained from the base hospital and be maintained at the vision centre.
Report generation:
1. Daily report on out patient visits.
2. Daily report on referrals sent
3. Daily report on revenue generated
4. Weekly report on data entry
5. Weekly report by community worker on volunteer program including training, referral, monitoring, awareness education etc.
Other activities:
1. Medical records maintenance
2. Accounts
3. Stock maintenance
4. Database management
5. Attendance register
6. Overall maintenance of the vision center

AT THE BASE HOSPITAL
Activities:

A system has to be in place to track all the referral cases either from the vision center or directly from the villages at the base hospital both at the paying and free section.
As per the hospital procedures necessary treatment will be offered to the patients.
At the end of every day a list has to be generated from the hospital on the number of cases visited from the vision center including details on their identification, clinical diagnosis, treatment given and follow up to be done.
All the above information has to be sent to the vision center through email for necessary follow up on daily basis.
List of children identified with problem requiring any intervention through school screening program should be sent to the vision center within 4 days from the camp date.

COMMUNITY LEVEL WORK
Activities:

Training Programme:
1. TOT training will be arranged for conducting community survey.
2. The number will be decided based on the population and the size of the village.
3. Training will focus on :
  1. Selection of trainers and volunteers (various kinds of people like traditional healers, trained or untrained dais, teacher, medical shop owners, youth club members) from the selected villages.
  2. Theoretical and practical exposure will be given on vision estimation.
  3. Maintenance of records and minutes and logbook.
  4. Issue of the required forms and referral cards for the survey at the end of the training.
  5. Rapport established with the local official people by the master trainer.
  6. Utilization of neighborhood agency.
  7. Sanga meeting
  8. Gram sabha
  9. Facilitating training to the reminder villages by the master trainer.
  10. Training given on mapping and clear picture of village and its culture and house hold practices
Selection of volunteers
1. Identify volunteers with help of master trainer.
2. Orientation given on community survey to the identified volunteers.
3. Implementation of the community survey
  1. Door to door survey.
  2. Household information including demographic details of the family members, eye care utilization and vision examination will be done.
  3. After any treatment the volunteer will monitor follow up and compliance and information will be recorded for individuals.
  4. Issue referral letter to the interested persons.
4. Getting details from the school, panchayat office, Taluk office.
5. Combined work with the other NGO staff.
TOT Training for general health awareness and eye care services
1. Training given for next set of selected trainers.
2. Theoretical and practical exposure will be given.
3. Basic eye screening
4. Approaching schools and public
5. Awareness creation with the help of posters, handbills, painting on the wall.
6. Special training given on conducting Cultural programme.
7. Street theatre techniques
8. Puppet show
9. Skit
10. Maintenance of records, logbooks and minutes.
11. Utilization of neighborhood agency.
12. Facilitating training to the reminder villages by the master trainer.
Strengthening the Man Power
1. Refreshment training will be arranged for the TOT and the volunteers.
2. Getting feedback from the volunteers and TOTs.
3. Reward given to the best performed group
  1. More number of person utilization of eye care services.
  2. Continuous follow-up the compliance.
Documentation
1. Documentation to be enhanced.
2. Usage of referral cards by the people.
3. Minutes recorded.
4. Maintenance of log book. (volunteers)
5. Review meetings will be conducted for the Volunteers by the TOT (every Saturday)
6. Collected data to be updated in the vision center (every day or every Saturday) given by the master trainer.
7. Referral letter given at the community to the people with vision problem.
8. Regular follow up by the community worker.
Monitoring the utilization of the eye care services by the community worker
1. Refractive error
  1. Spectacle usage
  2. Satisfaction and compliance.
2. Cataract
  1. Post operative medication and follow up recorded
3. Glaucoma
  1. Medication follow up and review check up
4. Diabetic Retinopathy
  1. Medicines
  2. Diet and exercises
  3. Review once in 6 months.
5. Pediatric
  1. Squint / Amblyopia check up and follow up of patching exercises
  2. spectacle usage and compliance
  3. Every year follow up and review.
Regular contact with the vision center
1. Weekly report to be sent to the master trainer from the vision center regarding their performance including no. utilized the eye care service, no. not utilized, no. need to be follow up for compliance etc.