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Blog: Much needed eye health services to Mahottari rural municipality, Nepal by Junu Shrestha

I, Junu Shrestha along with the HEPA Nepal team set out for an eye camp in Mahottari rural municipality in Province 2, Nepal on 16th June from Kathmandu. The arrangements for the eye camp had already been done by our local members of HEPA Nepal and the financial support was from Mahottari rural municipality. Our team comprised of eight health professionals: Dr. Dipak Kumar Sah, the president of HEPA Nepal, Dr. Buddhinath Sah, Lal Mohammad, Sonee Sah, Nitendra Jha, Dr Subash Chandra Singh and Dr. Sanjeeb Mishra and eight assistants. Mahottari rural municipality Mahottari rural municipality lies in Province 2, Nepal. Geographically this province is a plain land with much agricultural productivity. This province has amongst the lowest health and other development indicators in Nepal. It has the highest number of people below poverty line, highest number of school drop-outs, and lowest literacy.

There is no any eye hospital in Mahottari district and very less reported eye camps and eye screenings. We wanted to determine the prevalence of ocular morbidity, provide spectacles for refractive error, manage simple ocular diseases and facilitate referral for people with more serious conditions or requiring surgery.

Eye health awareness activities were performed by local health workers and public health officers a week before the eye camp. Posters with information on eye camp were hung on electricity poles, walls of school compounds, temple areas and health posts for publicity. Flyers with information on common ocular conditions like cataract, ocular trauma and their management were distributed to the local people there.

We conducted eye camps for three days, first day (17th June) at Gaurigamma health post covering ward number 5 and 6, second day (18th June) at Damahimadai health post which has people from ward number 3 and 4, and the last day (19th June) at Sonakhra health post covering ward number 1 and 2. At camp We started our eye examination at 10 am in the morning. We made arrangements in the health post for eye check-ups in the sequence of: first visual acuity assessment, then refraction, then slit lamp examination and finally to the medicine and spectacles distribution. We are very pleased to use the donated Keeler Ophthalmoscope for most of the examinations. We are obliged to IAPB and Keeler for the support. The retinoscope and ophthalmoscope was useful in detecting and diagnosing various ocular morbidities. More than 80% of the people presenting in the camp had one or more ocular morbidities. We found 332 mature cataracts needing urgent cataract surgery. A significant number of people had ocular surface disorders. We distributed over 1600 spectacles to correct refractive error and presbyopia. Only 11 patients had already undergone cataract surgery in both eyes.

The higher prevalence of ocular morbidity can be attributed to the fact that highest number of patients were of older age group (>50).

The participation of youth and adults was less in the eye camp. By this we can assume that they may have less ocular problems or they may have migrated away for higher education or for employment.

We are still looking for some helping hands to operate for cataracts.

These problems can be solved to a great extent if there was an eye health facility in the district. Services from the health posts and primary health care are not sufficient in Nepal to eliminate blindness. As the burden of blindness lies at the local level, the eye health professionals should serve at local level. For this, the government of Nepal should make provisions for an eye health facility with trained eye care personnel either by incorporating in existing health facilities or by establishing new ones.

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