Islandwide vision

By Kumudini Hettiarachchi

Every five seconds one person in the world goes blind, while a child goes blind every minute. These are the tragic statistics worldwide, the irony of which is that 75% of this blindness is treatable and/or preventable.

What of Sri Lanka?“The main cause of blindness is cataract. We have also identified four other emerging diseases to be tackled on a priority basis. They are glaucoma, diabetic retinopathy, childhood blindness and refractive errors and low vision,” says Consultant Ophthalmologist Dr. Mangala Gamage stressing that the need is to detect and treat them at the correct time. “This is also the objective of the Vision 2020 initiative.”

Dr. Mahipala

‘Vision 2020: The Right to Sight’ is a global initiative of the World Health Organization and the International Agency for the Prevention of Blindness launched in 2000, to prevent and control avoidable blindness in the world by the year 2020. Sri Lanka is a signatory to Vision 2020.

And the strategy to be adopted in achieving this goal, according to Dr. Gamage, will start right at the grassroot level, with comprehensive plans being drawn up to integrate primary eye care into the primary health care programme of Sri Lanka.

Adds the Deputy Director-General of Public Health Services Dr. Palitha Mahipala, having a time-tested and very successful model for Southeast Asia, in Sri Lanka’s public health system which deals effectively with other diseases, it is essential to integrate primary eye care into this.

Pointing out that the health care service in Sri Lanka can be broadly divided into two categories – preventive and curative – he explains that the primary health care unit (on the preventive side) ranging from the Medical Officer of Health right down to the health care worker who visits homes, should be mobilised to identify eye problems and direct those who need treatment to a health institution (on the curative side).

“The need is to train those at the grassroots or community level to identify simple eye problems for which first-aid can be given in homes themselves along with advice to families on how to prevent home accidents which could lead to blindness,” echoes Dr. Gamage. “They should also be trained to assess the cases which need urgent or routine referral to the closest healthcare institution.”

The horror of a cracker: A child gone blind

That would be the closest dispensary, peripheral unit or rural hospital dubbed the primary healthcare institutions from where the patient gets into the hospital system depending on the gravity and urgency of the eye problem, explains Dr. Mahipala detailing the chain as secondary (district and base hospitals) and tertiary care (general, provincial and teaching hospitals).

“Nearly all provincial, general and base hospitals now have eye surgeons, except for a few, so a good referral system is a must,” says Dr. Gamage, adding that then the centre of excellence for eye care and treatment, the Eye Hospital in Colombo could deal with the complex cases. Adequate manpower at community level and good training programmes for them, she points out, would be essential while in hospitals there should be infrastructure and equipment.

Another vital aspect is making people aware of injuries and infections which could lead to blindness, most of which would be preventable, says this Eye Surgeon citing the example of those engaged in certain types of livelihoods being educated on the need to wear protective gear.

Dealing with childhood blindness through accidents which are 100% preventable, she says once again awareness programmes are important. For childhood eye diseases, the screening procedure should be strengthened. “We have screening of children in schools, which we must develop more while we need to begin screening programmes at pre-school level too,” she stresses.

Last week, Sightsavers International, a charity based in the United Kingdom that works in more than 30 countries in Asia, Africa and the Caribbean to prevent blindness, held a Workshop on Regional Primary Eye Care, in collaboration with the Health Ministry to share experiences, and document lessons learnt and best practices.

Sightsavers also committed to Vision 2020, has been working in Sri Lanka since 1980 and has been contributing to the development and expansion of facilities to prevent blindness.