Community Eye Care: Reaching the Unreached

Nepal is one of the poorest countries in the world, and over 80% of the populations live in the rural villages. The prevalence of blindness in Nepal is around 1% and the leading causes of blindness are cataract, trachoma, nutritional deficiencies (Vitamin A), injuries, etc. which are either curable or preventable. This situation on eye health is obvious indicators of a least developed socio-economy, as developed countries have <0.5% of prevalence of blindness and none of the above said diseases are the major causes of blindness.

Despite of armed conflict in Nepal, as a neutral organisation, Nepal Red Cross Society (NRCS) has profound access to the community. The country is facing serious impact of armed conflict and that has further deteriorated reach of basic services to the people living the remote areas. NRCS is one of the leading agency provides curative, promotive and preventative eye care services in Nepal with the financial and technical support of Swiss Red Cross (SRC). The main objective of the programme is to fight against the poverty induced needless blindness in 2 zones (out of 14) in Nepal. CEHP (Community Eye Care and Health Promotion) is one of the joint projects of NRCS/SRC serves mid-west development region of Nepal and mobilization of volunteers to reach the unreached for health promotion is one of the important components of the programme. CEHP supports conduction of various community outreach activities to provide curative, pomotive and preventative activities to NRCS, and school eye health is one of the important activities to reach the unserved.

School Eye Health Activity

In the rural setting in Nepal, the school teachers are not only delivering education to the students but also playing a role of community resource person for all sorts of health and development issues. The community members consult teachers to seek solutions to their issues, and as an intellectual the teachers in the rural community have effective influences to the community members to resolve the issues. Seeing this potentiality, NRCS has mobilized the school teachers in primary eye care as well. NRCS has its Youth/Junior Red Cross wing in almost all middle and high schools in the country, led by one of the teacher of the school. CEHP programme through school eye health aims to enhance understanding of teachers on socio-economic impact of blindness in the society and enables them to support, educated, counsel and refer the eye patients from the schools and communities to the proximal community eye centres or hospital. CEHP trains over 200 teachers each years and targets reaching over 600 (with over 90% coverage) schools of from Bheri zone (5 districts) and 2 districts of Karnali zone in mid-west development region by 2007.

The Process

In collaboration with the local Red Cross unit and the District Education Office, the CEHP and its community eye care centres provide 3 days intensive training on primary eye care to the school teachers, focusing on common eye health problems in school students and community cause blindness. The training also imparts skills to screen vision (sight). The teachers are also made fully aware about the services available in the proximal eye centre or hospital. Practical sessions are organised as school visits and eye screening camps to visualise the eye health problems to the teachers. During these sessions the teachers exercise vision testing, eye health education and counselling for the eye patients and students. The teachers are provided with a vision chart, information-education-communication materials for eye health education, primary eye care booklet and referral forms. Following the course the teachers carry out vision assessment of all students of their school twice a year; usually at the beginning and middle of the academic year. The students found with abnormal vision or any other eye problems are informed their parents and are referred to the students to the near by eye centre or eye hospital for further management. Each school provides vision assessment report to CEHP and the staff responsible analyse them. Based on the information of the report, a paramedical staff (ophthalmic assistant) may go to the school to carry out further examination. This process is done only if the school is located far from the eye centre or hospital. Around 5% of the children are found with eye health disorder and the major reasons are cataract, refractive error, corneal opacities, xerophthalmia, trachoma, conjunctivitis, squint, amblyopia, etc. CEHP has provision of subsidy for the students could not afford surgical and medical intervention at the hospital.

The trained teacher also carries out eye health education sessions at the school to inform about the preventative measures. The teacher asks the students to disseminate the eye care message in their family and in the neighbours.

Effective conduction of teachers training is the most important part for the success of the school eye health programme. It has to be designed participatory and skill based, then it gives a strong value and motivation to the teachers for their commitment to work for the people. We always found the teachers enthusiastic on learning about eye care and prevention of blindness. Mr. Kaman Singh Khanal, 35, teacher at Mahadevpuri Primary School at Banke district is proud to learn about eye care. He has successfully completed vision test of all 320 students of his schools and referred 17 students to Nepalgunj eye hospital for further management. In response to his work, he has already got a thanks letter from CEHP. Recently he has also escorted Mr. Daljeet Khatri, 65 years old to Nepalgunj eye hospital who had no capacity to reach the hospital. Mr. Daljeet was operated at Nepalgunj eye hospital and could see again. Mr. Khanal said it was one his punya karma (holy work) that helped to restore invaluable sight. Thus, the school eye health is an effective tool for social marking of eye care services.

Further, the community eye care of CEHP adopts fundamentals of "Vision 2020: The Right to Sight" global initiative to fight against avoidable blindness also give a high priority to the activities targeted for children, as their suffering with blindness has enormous socio-economic impact to a family and society. Thus the schools health programme is a successful attempt to reach a wide area in the rural communities cost effectively. CEHP's school eye health programme will reach around 125,000 school children and 100,000 families during 3 years period.