Dear Readers,
Outreach programmes for eye care should aim at reaching the unreached. Many health care institutions organize outreach activities to create awareness in the community, educate the community on health, and to provide possible medical intervention. There is a need to extend health care facilities to rural masses in order to cover the vast majority of the population. In India, health care facilities are distributed in such a way that 80% of facilities are available in urban areas and 20% in rural areas, where as the population distribution is vice versa: approximately 20% of the people are urban and 80% are rural. Reaching the underserved can be done effectively by organizing outreach programmes in rural areas and following a base hospital approach. Once the quality of care reaches a high standard, the community will be more aware and open, making the task of the eye care providers much easier.
This Sitenews uses a general approach to the understanding of reaching the unreached including introduction,Access and delivery system of community ophthalmology. This issue introduces you to the Awareness program,Services in remote and rural areas, and Eye camps.
Issue covers Global consortium of eye care services and also provides a biography of Dr. Sir John Wilson A brief note on SEVA an organisation providing support for the poor blind especially in remote areas is also included in this issue.
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Regards,
Library Team
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LEAD KINDLY LIGHT, REACHING THE UNREACHED
In the present circumstances and environment, it was inspiring to see, how a MBBS doctor has put all his dreams in mainstreaming the tribal citizens of Karnataka for the last 25 years through Vivekananda Girijana Kalyan Kendra (VGKK), at BR Hills. When I visited BR Hills in 1998 and subsequently in 2006, I could see substantial new developments in that area. I could see that New Tribal Hospital, roads and education environment and above all the earning capacity of the tribal citizens have been increased with the technology resource centre as a base. Dr. H. Sudarshan, is the inspiring architect of this societal transformation.
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"REACHING THE UNREACHED - THE ARAVIND ODYSSEY
Despite increasing amount of surgical interventions, the number of blind people due to cataract is increasing in the third world in general and India in particular. In the last two decades, India pioneered the advent of mass scale cataract surgical eye camps as a measure to stem this increase. Though these camps are useful they are not the ultimate solution for this age old problem. Nothing reflects this better than the increasing number of blind people to cataract every year. Realising the low cost effectiveness in conducting surgical eye camps and at the same time, realising the advantages of a base surgery, Aravind started conducting comprehensive diagnostic eye camps which benefits a larger spectrum of visually handicapped. These camps act as a population screening service, a non surgical treatment service for eye disorders and a referral services for patient requiring surgery.
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GLOBAL CONSULTATION ON REACHING THE UNREACHED
This report captures the learning that came out of the Reaching The Unreached workshop held at LAICO, Aravind Eye Care System, Madurai in October, 2007. The workshop was structured to focus on each eye disease by articulating the magnitude and the current challenges and trends. Discussions brought out the best practices that could help build a service delivery model to reach the community and resources required to do this.
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HOW CAN HOSPITAL PROGRAM BE STRENGTHENED TO ENHANCE ACHIEVEMENT OF VISION 2020 OBJECTIVES?
The challenge to realize this goal would be designing the right service delivery systems specific to the local context, organizing the required resources, coordination, and implementing and monitoring these. The key discipline that is required to ensure successful implementation is Management. To be holistic, such management inputs are required both in a program as well as the hospital setting. From a program perspective, the focus will need to be on reaching the unreached, ensuring equity, creating an enabling environment, putting in place the required infrastructure, including that for developing all cadres of the eye care team, and functionally integrating eye care into the general health system and other developmental activities.
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ATTACKING THE BACKLOG OF INDIA'S CURABLE BLIND
The number of individuals in developing nations with preventable blindness from cataract and other disorders is increasing. New programs incorporating local customs and efficiently using available resources must be created to prevent the escalation of blindness and to rehabilitate patients already disabled with cataracts. We describe a system of high-quality, high-volume, cost-effective cataract surgery, using screening eye camps and a resident hospital. This has enabled us to provide efficient low-cost cataract surgery and overcome barriers of adequate eye care in southern India. We have been successful in locating patients with treatable eye problems, educating them about the availability of ophthalmic care, and providing free eye care. Our structure stresses the following: community involvement, identification of individuals most likely to benefit from screening, efficient utilization of both medical and paramedical personnel, and a streamlined approach to screening patients. This system may be capable of modification for use in other developing areas to decrease the backlog of cataract blindness.
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ABORIGINAL EYE CARE: A REVIEW OF SERVICES IN NSW
In countries where lack of resources is a major problem, the careful management of financial and other material resources can be what keeps a programme alive. A good management structure ensures that human resources are available in quantity, quality and deployment and that they have the infrastructure and technology to deliver services. Belbins team roles become particularly pertinent in the management team. VISION 2020 a shared vision requires teams whose members have a functional as well as a team role to deliver it.
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ACCESS AND BARRIERS TO VISION, EYE, AND HEALTH CARE
Access to vision, eye and health care is a major problem in the United States. Without access to care, an individuals health and quality of life are reduced and diseases are not prevented, diagnosed, treated or managed. Without access to vision care, individuals may not be able to effectively participate in their communities, drive safely, perform effectively on their jobs, read, learn in schools, access information needed for activities of daily living, avoid accidents and falls, and will not have adequate protection from eye injuries and accidents. All other vision, eye and health care issues are secondary to having access to care.
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FHF CREATES A SUSTAINABLE EYECARE PROGRAMME FOR A RWANDAS PROVINCE
The Fred Hollows Foundation works on Rapid Assessment of Avoidable Blindness (RAAB) a program that works with the most needful people and side-by side with the local people to focus on sustainability of a crucial part of the body-the eye. They are trying to end avoidable blindness in unprivileged communities within the country.
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REACHING INTO THE DISTRICT: STRENGTHENING THE EYE CARE TEAM
VISION 2020: The Right to Sight has provided a vision and a common goal for eye care programmes. It has provided the paradigm shift, or change in the way of
thinking, from individual patient care to population care, a shift from each person doing a job or task, to a group working to eliminate avoidable blindness. Such a common goal needs a team approach.
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REACHING OUT: A STRATEGY TO PROVIDE PRIMARY EYE CARE THROUGH THE INDIGENOUS EDUCATIONAL SYSTEM IN PAKISTAN
This article reports a study on a system of education called Madaris that was carried out in 2002 in the district of Peshawar, the capital of the North-West Frontier Province (NWFP) of Pakistan which has a population of 2.5 million. It aimed to determine the prevalence of blindness and low vision among students in the age group of five to 15 years. It offers an agenda for primary eye care and highlights the importance of integrated health care reforms at the national level for this large non-government community education system that caters to an estimated half a million children throughout Pakistan
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EYE CARE SERVICES TO THE REMOTE AREAS OF BHUTAN
The Primary Eye Care Program entails providing equitable quality services to people
of all walks of life in every corner of the country irrespective of race, caste, creed,
wealth, literacy etc. Since the start of eye care services in the country, much has
been achieved. However, reaching the services to the unreached has gained priority,
especially to enhance the Vision 2020 activities.
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PROVIDING EYE CARE TO REMOTE INDIGENOUS COMMUNITIES IN THE NORTHERN TERRITORY: A CASE STUDY EXAMINING SUCCESS FACTORS AND CHALLENGES FROM A COLLABORATIVE APPROACH BETWEEN A NGO AND AMS, ... BY T KEYS
There are many barriers to indigenous people seeking eye care. A lack of funded services within indigenous and non-indigenous controlled facilities has long been recognised as a major barrier. Other barriers include perceived cost, transport and access difficulties, lack of eye health awareness, and lack of eye care practitioners with knowledge of indigenous culture. A Northern Territory Aboriginal Medical Service (AMSAnyinginyi Health Aboriginal Corporation) invited a Non Government Organisation (NGO) to help overcome these barriers.
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ENABLING EYE CARE IN RURAL INDIA - RESEARCH AT INTEL
The scenario above was enabled by a collaboration involving researchers from Intel and UC Berkeley, with support from the National Science Foundation. Together they are helping the Aravind Eye Care System, a network of five hospitals in south India, in its quest to deliver affordable, quality eye care services to the rural poor. Their contribution: a custom long distance, high-bandwidth, point to point Wi-Fi network that connects rural vision centers to Aravind hospitals. This experimental network will
enable rural residents to have video consultations with doctors, eliminating the need for patients to travel to the hospital for routine eye care.
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OUTREACH SCREENING CAMP IN THE REMOTE AREAS PROVIDE SERVICES AT THE DOOR OF POOR PEOPLE.
Most developing countries are now challenged with the problem of blinding cataract besides a huge backlog. India has perhaps the largest blind and potentially blind population in the world. In the rural areas where health care facilities are primitive, blindness is more pronounced (1.62%) constituting over 75% of the population than in urban areas (1.03%). Because of their unawareness and poverty, the rural people continue to remain needlessly blind. The social and financial hardships created by blindness gravely affect individuals and families in particular and the nation at large.
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OUTREACH: LINKING PEOPLE WITH EYE CARE
Service delivery in prevention of blindness is usually based on two different models. The first model focuses mainly on making eye care accessible to as many people as possible. This model is best employed in the urban areas of a country, where there are sufficient eye care professionals, but many of the poor cannot afford eye care from their small household budgets due to the high cost of services. Establishing high-volume reputable eye hospitals in these areas can reduce the cost of eye services to a level that is affordable for most of the population and leads to a sustainable service.
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BEYOND THE CLINIC: APPROACHES TO OUTREACH
By making elimination of needless blindness its prime objective, VISION 2020 has introduced a major paradigm shift in the planning and delivery of eye care. For many service providers and other stakeholders in this global initiative, this is both a challenge and an urgent call to move quickly from reaching as many as we can strategies to new approaches that insist on doing it right and enough to make a lasting impact. How does one achieve this in the poorest and neediest parts of the world where service delivery is quite often synonymous with dysfunctional infrastructure, limited access to and use of existing eye care services? This is what makes current discussions on
reaching out beyond the clinic so relevant and so urgent.
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OUTREACH EYE CAMPS: A CASE STUDY FROM WEST BENGAL, INDIA
People were familiar only with makeshift surgical camps in school buildings and community halls. This case study shares with you the experiences of an eye hospital run by Vivekananda Ashram Mission in conducting outreach camps.
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STRENGTHENING GENDER AND DISABILITY INCLUSIVE APPROACHES TO COMMUNITY EYE HEALTH TO REDUCE AVOIDABLE BLINDNESS
This program is reducing avoidable blindness and disability by strengthening provincial level services through improvements to Takeo Eye Hospital, while developing a district level Vision Centre and Optical Shop in Kiri Vong. By integrating a strategy for gender and disability inclusion, this program is enhancing access to eye care, rehabilitation and education by people with disabilities, women and girls.
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AN INFRASTRUCTURE MODEL FOR THE IMPLEMENTATION OF VISION 2020: THE RIGHT TO SIGHT
Blindness is a serious public health problem globally. Eighty percent of this problem is avoidable, i.e., either preventable or treatable; 90% of the problem manifests in the developing countries of the world. Over the past 30 years the magnitude of blindness has steadily increased, with southeast Asia carrying the greatest burden (disproportionate to the size of its population), followed by the western Pacific region, sub-Saharan Africa, Europe, Eastern Mediterranean and Latin American regions. In light of these observations, all the major groups and organisations involved in the prevention of blindness around the world realized that a major shift was warranted in the strategies to control blindness. This led to the development of the Global Initiative for the Elimination of Avoidable Blindness, given the name VISION 2020: the Right to Sight.
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Sir John Wilson
In 1950 Sir John Wilson founded Sight Savers International - formerly known as the Royal Commonwealth Society for the Blind. He led the organisation for more than 30 years, during which time one of his great strengths was his genius for innovation. He was involved in establishing some of the essential elements of today's eye care services in developing countries. These included mobile outreach programmes and the training of ophthalmic paramedics. Sight Savers also funded early research into the little understood disease of onchocerciasis. Training schemes for blind people in rural areas proved that they could farm as successfully as their sighted neighbours.
Sir John was also instrumental in revealing the scale of world blindness - the first conservative estimate at over 15 million people - and he set about stimulating the global collaboration which was essential to tackle human suffering on such a scale. He played a key role in establishing the International Agency for the Prevention of Blindness (IAPB) and was its first President.
Sir John retired from Sight Savers in 1983, but maintained close links with the organisation. The pace of his life did not slacken. He founded the IMPACT movement, a global initiative to prevent major causes of disability, and his international travel schedule continued up to the time of his death.
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SEVA FOUNDATION: COMPASSION IN ACTION
For over 30 years, Seva has been developing sustainable global eye care programs. Nearly three million blind people see again, thanks to affordableeye care services implemented throughout Asia, Africa and Latin America. In the past year alone, Seva-supported programs served more than 500,000 people worldwide, 25,000 children received care to prevent blindness and over 30,000 people received cataract surgery to restore their eyesight.
How does a small organization like Seva make such a big impact? Through a dynamic network of partners around the world, Seva helps communities develop their own high-quality, affordable eye care services.
Seva is an active member of VISION 2020: The Right to Sight, a far-reaching initiative of the World Health Organization and the International Agency for the Prevention of Blindness that aims to eliminate avoidable blindness by the year 2020.
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INTRODUCTION 
REACHING THE UNREACHED 
ACCESS AND DELIVERY SYSTEM:
AWARENESS PROGRAM 
SERVICES IN REMOTE/RURAL AREAS
EYE CAMPS
GLOBAL CONSORTIUM
FEATURED PERSONALITY
FEATURE ORGANISATION
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