Sight for sore eyes
A visionary community project is bringing first class eyecare to Delhii slum-dwellers. Malcolm Doney reports.
Ramwati didn't know what was wrong with her eyes, just that one of them hurt and she couldn't see very well out of the other. She has been wearing glasses for a couple of years, but this hasn't improved things. What she did know was that there was an eye clinic in V P Singh Camp, the south Delhi slum where she lives, and she has come this morning to seek help.
Forty or more people cram into the narrow street outside the shabby schoolrooms where the clinic is held. Trained volunteers (many from the local community) register patients, hand out information leaflets and undertake a routine vision test with a chart tacked up on a nearby wall. Already this morning there has been a group eye health education session for locals, and once the clinic closes there will be a training session for community volunteers. Right now, people are lining up for tests and treatment. Some, like 48-year-old Ramwati, are here for the first time. Others, like Musha, 55, is returning for more treatment. Some are children, like five-year-old Sunu.
The clinic is supported by Sightsavers International – one of ten satellite community clinics in the orbit of the Rajendra Prasad Centre for Opthalmic Sciences of the All India Institute of Medical Sciences in Delhi. This remarkable centre of excellence is the first World Health Organisation (WHO) centre for eye services in India and has a considerable training, research and treatment programme – including 25 faculty members, 33 senior resident doctors and 75 postgraduate students. As well as the WHO and Sightsavers, the centre is also linked with the London School of Tropical Medicine and Vision 2020. When the centre started a community eye care programme for people in the city's poor districts in 1992, it opened world class facilities and expertise to those most vulnerable to eye disease.
"Poverty contributes to blindness," says the Centre's Assistant Professor of Community Opthalmology Dr Praveen Vashist, continuing, "and blindness causes poverty". People who are poor cannot afford or do not have access to eye care, he explains. And poor diet has a serious effect, "Twenty-nine per cent of childhood blindness in India is caused by vitamin A deficiency". And once you lose your sight, he adds, it is difficult to earn a living. That's why The professor is visiting V P Singh Camp, where up to 10,000 people are living cheek-by-jowl, often squeezed six to a room, with minimal sanitation and water provision.
Ramwati has been told she needs a cataract operation - cataracts account for 60% of all blindness in India. – and thanks to the support of Sightsavers' she can go to the opthalmic centre and have the cataract removed. It's an operation which costs £20-30. But the operation is not quite so straightforward for Ramwati. "I'm very scared," she says, “but I know I need an operation and I have faith in the doctors…" She hesitates, "…but tomorrow I might change my mind."
Dr Vashist has anticipated her nervousness. "The hospital is crowded and the outpatient procedure seems complicated," he acknowledges. "So I will tell her to come straight to my office, along with the other eye patients. There, I'll provide an escort for her so she knows exactly where to go."
She can draw confidence from the witness of Musha. He was almost completely blind in one eye because of a cataract, but now his sight is restored. "I'm so happy," he says. "It's unbelievable to be able to see again. I make a living as a labourer. When I couldn't see properly I wasn't able to work. But now I can." He's back at the clinic to have his other eye treated, and he can't wait.
Sunu sits patiently while he is examined. His problem is more serious. His mother doesn't live in V P Camp, but she heard about the clinic from a local. One of Sunu's corneas is damaged, possibly from vitamin deficiency, and it needs to be replaced. It's a serious procedure but Dr Vashist says he will be placed on a priority list and should be treated within three months. His mother is worried, but relieved. For a slum child like this to get access to top class treatment – it's quite a sight to see.