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And Then There Was Sight

A child receives treatment at the Dr. K. Zaman BNSB Eye Hospital in the northeastern district of Mymensingh, Bangladesh. Credit: Naimul Haq/IPS

MYMENSINGH, Bangladesh, Jun 24 2014 (IPS) - There was a time when four-year-old Taiba, a resident of Makril village in Bangladesh’s central Netrokona district, had little to smile about. The early years of her life were spent trying to cope with bilateral congenital cataracts, referred to in her village simply as ‘child blindness’.

The cloudy film on her natural lens made it difficult to recognise things, and her parents were beginning to despair that she would ever lead a normal life.

Now, sitting in the waiting room of a small surgery 125 km north of Bangladesh’s capital Dhaka, Taiba and her family can scarcely hold back their tears as they explain that, thanks to a recent surgery, her vision has been restored.

The facility responsible for bringing them such happiness, known as the Dr. K Zaman BNSB Eye Hospital located in the northeastern district of Mymensingh, is bent on treating every child suffering with cataracts. In Bangladesh that number stands at some 40,000.

“The lifelong economic gains of prevention and treatment of [child blindness] in Bangladesh would be 1.1 billion dollars." -- Findings from a study by Orbis International
Since 2006 the NGO-run facility has provided eye care services to thousands of children, most from rural areas, who cannot afford treatment in large private hospitals.

Taiba’s father, Abdul Quddus, tells IPS he traveled 80 km to bring his daughter here, and paid just 38 dollars for the surgery, which usually costs 190.

He believes the price was more than worth it to see his daughter “play with other children in the village and read books at home in preparation for school.”

The surgery was performed in January, and later this month Taiba will return to have her second eye corrected. Until then, she is closely monitored on a monthly basis for any changes in her sight, or any side effects to the operation.

Though bilateral cataracts, sometimes called ‘infantile cataracts’, are relatively easy to correct in young children, the process gets more complicated as they grow older. The hospital’s coordinator, Sharifuzzaman Parag, told IPS, “Finding children with [bilateral] cataracts in villages is a major challenge and often by the time we identify them it is too late – they are already blind.”

He added that the success rate of surgeries decreases as a child gets older, and that it is crucial to devise methods to identify and treat the condition as soon as possible.

The hospital, in collaboration with Orbis International, has been campaigning to build awareness on bilateral cataracts in rural areas. Together they have established outreach centres that dispatch groups of trained paramedics into villages to inform parents how to identify symptoms early on.

While the campaign is certainly helping to save children from blindness, it has spotlighted Bangladesh’s lack of preparedness for dealing with the issue.

According to Mohammad Abdus Salam, a senior eye surgeon with over 22 years of experience, increased awareness has put tremendous pressure on facilities to deliver services and provide care. “We often get hundreds of registrations at a time,” he told IPS.

Sadly, the number of facilities dedicated to the prevention and treatment of child blindness are few and far between. The hospital in Mymensingh is the only well-equipped tertiary-level eye care facility in the entire region, serving about 17.56 million people in six districts.

To strengthen its facilities Orbis has funded a national logistics expansion programme that will enable it to provide more surgeries. A state-of-the-art operation theatre is already in place to cope with around 450 surgeries per year, but grassroots volunteers say it will need to deal with over four times that number, as referrals through their outreach centres have substantially increased.

The National Blindness and Low Vision Survey conducted in 2002 shows that the blindness prevalence rate in Bangladesh is 1.53 percent. It is estimated that for every one million people in Bangladesh, there are 300 blind children, of which around 100 lose their vision due to cataracts.

“This is a huge burden,” Professor Enayet Hossain, program manager and head of the pediatric unit at the National Institute of Ophthalmology (NIO), told IPS.

“As parents lack sufficient knowledge on the issue we strongly recommend the launching of screening programmes for newborn babies. This would enable the government to identify and register those children on the spot.”

This, too, is easier said than done, as only 14 percent of Bangladesh’s massive rural population seek healthcare services from formal medical centres.

The vast majority – about 57 percent of the roughly 71 million people living in rural areas – relies on local healers, known as ‘palli chikitshoks’, for consultation and treatment.

Hossain pointed out that the long-term economic benefits of increasing eye care for children are well worth considering.

“Those blinded at birth incur a higher economic cost to their family members and society than adults blinded later in life. So, an eye screening programme [would bring] national economic benefits,” he stressed.

A 2012 study led by Abu Raihan, regional programme director of Orbis International, found that in 2006, a total of 7,661 pediatric cataract surgeries were performed at the cost of 1.2 million dollars.

The cost of treating all 40,000 cases of childhood blindness would have amounted to some 4.5 million dollars that same year. While this is a substantial figure, the study also calculated that the annual gain for the country’s gross national product (GNP) of treating all child blindness cases would amount to roughly 32 million dollars, making the endeavour more than worthwhile.

“The lifelong economic gains of prevention and treatment of [child blindness] in Bangladesh would be 1.1 billion dollars,” the study added.

But it appears this study did not reach policy makers around the country, since the total budget allocated to eye care annually is less than 550,000 dollars, what experts call an “insignificant” amount.

Bangladesh has just 900 ophthalmologists, a paltry number in a country whose population stands at 160 million.

There are only 18 ophthalmologists for the country’s 66 million children. Most of them practice in the cities and at private clinics, in just ten specialised care units for children.

Despite claims of being equipped to provide eye treatment services, most district hospitals remain non-functional due to a lack of equipment, support staff and doctors.

Surveys reveal that 86 percent of the cataract surgeries for children are performed in eye hospitals run by NGOs, while just 10 percent are conducted in government hospitals in urban areas, and the remaining four percent are dealt with in private hospitals.

While the government struggles to cope, civil society is stepping in to fill the gap in healthcare.

Orbis International, for instance, has launched a National Childhood Blindness Reduction Programme, which will train over 2,000 eye doctors and other supporting professionals, with a special focus on children’s cataract surgery.

The organisation plans to strengthen its local referral system by implementing a database covering all of the country’s 64 districts, with a target of reducing catarct-related blindness in children by 50 percent.

Orbis International Country Director Dr Munir Ahmed told IPS, “Over the next five years, we will jointly work with the government on reducing childhood blindness by increasing access to quality eye care services in Bangladesh.”

He said the establishment of 10 high-quality pediatric hospitals would serve as a kind of nationwide network for dealing with the issue.


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