Blindness

Blindness in India: Effort of a Dutch Foundation to address the problem

By Dr. Shivananda Chairman Shared Vision Foundation – the Netherlands

It’s a poignant tragedy that India has one of the largest quanta of blindness in the world. There are 12 million blind people in India – more than one third of the total blind population of 32 million in the world.
More astonishingly, there are three and a half times more people than this who are visually impaired due to refractive errors or low vision. Indian National Program for the Control of Blindness (NPCB-India 1989) has estimated that about 45 million children and adults in India are visually impaired and need eyeglasses to correct their poor vision.
As shown in Table 1-cataracts (a condition causing clouding of the lens of the eye leading to progressive loss of vision) and uncorrected refractive errors (a condition when cornea & lens cannot focus the image of an object sharply on the retina) are two leading causes of blindness in India.
Both conditions can be easily corrected if you have the money to pay for cataract surgery & transplant of IOLs (intra-ocular lens) & correction of refractory disorders and purchase of new eye glasses.

Table 1. Leading causes of blindness in India
Refractive errors
19.65 %
Cataract 72.76 %
Glaucoma 9.58 %
Posterior seg 5.57 %
Surgical complications 1.46 %
Corneal opacity 1.35 %
Post Cataract Capsular opacity 1.24 %
Others: (phthisis, amblyopia) 6.59 %

(Source: Murthy GV et al. Br J Opthamol 2005. 89: 257-260

The highest prevalence of blindness in India is in the state of Tamilnadu where 2.65% of the total population of the state is afflicted.
Next to Tamilnadu, the state of Rajasthan has the second highest prevalence of blindness in the country where 2.5 % of the total population of 68.6 million in the State is affected. This means that there are nearly 1.7 million blind people in Rajasthan.

Western Rajasthan

A large proportion of the blind & people with impaired vision- live in Western Rajasthan. This is one of the poorest areas of the state– with an estimated income of one US$ 1–per day in the rural population, high infant mortality (77—per 1000 live births) and neo-natal mortality (67 per 1000 live births) and the life-expectancy for men is 53 and for women it is 54. A large proportion of the blind people live in remote villages—far away from the City.
The key factor which limits access to the preventive & curative eye care services in this part of Rajasthan is the lack of trained eye care professionals in the rural part of the State. For example 79% of the population of Western Rajasthan lives in the rural areas, whereas, 95% of the trained professionals– such as the ophthalmologists, optometrists & opticians work in the city.
A multitude of other social and physical barriers such as the inability to pay for cataract surgery & IOL transplant due to poverty, high cost of a pair of new eye glasses, payment of doctor’s fee for eye examination– and the long distances from village to the City which requires bus fare that they cannot afford— discourage village people from obtaining preventive & curative eye care services.

It is to address this problem that the Shared Vision Foundation was organized. It is a Dutch Foundation—registered as a non-profit charity in the Netherlands.
It is based in—Oegstgeest— a suburb of Leiden—the city where the famous University of Leiden is located.
The 6th President of the United States-John Quincy Adams & his brother Charles were enrolled at this University as students–during their father’s term as American Ambassador to the Republic of the Netherlands’s in 1780.

Since its inception in 2004 –our Foundation has spent nearly one million US$ to address the problem of visually disabled and to improve the life condition of children & adults with multiple disabilities living in remote villages of Western Rajasthan. It is all Dutch money—donated by large Foundations in the Netherlands.

Our principal partner in this work is the Blind Peoples Association of India (BPA) located in the City of Ahmadabad in Gujarat. BPA also provides financial control of our Foundation funds in Rajasthan. It is a nationally respected large NGO (non-government organization)—active in the rehabilitation of the visually disabled and people with multiple disabilities through education, job training & job placement (www.bpaindia.org).

Mobile Refraction Clinic

The program of the Shared Vision Foundation is called the Mobile Refraction Clinic (MRC) and Community Based Rehabilitation (CBR) for children & adults with multiple disabilities.
It is an interventional “screen & treat” program based on the principle of village outreach. At the moment it is serving a population of 2 million— spread over 860 villages of the Jodhpur District of Western Rajasthan.

Under the MRC the Foundation holds one Eye Camp each month in different geographic locations of the District and takes eye specialists right into the heart of the village population. Anywhere from 500-1000 men, women and children attend the Eye Camp. People with refractory disorders are given new eye -glasses. And, those who have cataracts and other eye problems are taken to an Eye Hospital in the city of Jodhpur and offered surgical/or medical treatment. All treatment, including the eyeglasses is free- of- charge to the recipients.
It is a very successful and active program and has been in operation for the past eight years. Since its inception in 2004—as shown in Table 2–we have held 53 Eye Camps, and have served a rural population of nearly 1.4 million scattered over 860 villages of the Jodhpur District of Western Rajasthan.

Table 2. Summary Data on all the Eye Camps held from 2004-2011
Year
No. Eye Camps
No. ScreenedFor Visualimpairment
No.Refractorydisorders
& new
Eyeglasses

given

No. Cataract
operations
Villagepopulations

Served

2004 3 2.117
345 175  38.000
2005 1 1.300
 372  104 20.000
2006 10 6.925
 5.461  173  148.000
2007 12 9.701
 7.432  269 248.500
2008 10 6.074
 5.068  165 179.100
2009 17 14.241
10.152  145 239.600
2010 4 3.785
 830  86 108.000
2011 17 5.375 2.955 233 417.139
Total 53 49.518 32.615 1.350 1.398.339

32.615 men, women & children have been given new eyeglasses and 1’350 people have had cataract operation and IOL transplant (www.sharedvision.nl). The number of people detected with cataracts, however, is much higher than those who agreed to have cataract surgery. Many old people refuse to go for cataract surgery because their family member or a family friend has told them that surgery is dangerous and they could die on the operating table!

Program Expansion

We plan to expand the MRC project to the rural areas of all the 6 Districts in Western Rajasthan with a population of nearly 10 million.
To get an empirical measure of the unmet need for eye care services in the population of these outer Districts, we have held two pilot Camps.

The first Eye Camp was in the District of Pali at a nodal village called Sardar Samand. It is 60 km away from away from the City of Jodhpur. 717 men, women and children were registered for screening at this Camp. Of this, 76% had refractory disorders; 44% needed minor medical attention to the eyes; and 4% needed cataract surgery.

Table 3. Urban-Rural Distribution of Population in Western Rajasthan
Name of
District
Population
RuralPopulation
Number of
Villages
given
Jodhpur 286,505 67 %
860
Jaisalmer 508,247 84 %
539
Barmer 1,964,835 93 %
 670
Jalore 1,700,000 93 %
 676
Sirohi 851,107 60 %
 673
Pali 1,820,251 78 %
943
6 Districts 9,730,945 79 % (average)  4,361

The 2nd Camp was held at a market town in the District of Jaiselmer. At this Camp, 942 men, women & children lined-up for screening. Of these, 86% had refractory disorders and needed new eyeglasses; and 2% needed cataract surgery.

The diagnostic data collected by our field staff—for refractory disorders (such as myopia, presbiopia & aphakia), cataracts and other eye problems, the age & sex distribution and the caste of the people who lined-up for screening show that a large number of tribal and low caste people have attended these Camps. They are the poorest of the poor in the Rajasthan villages.

Scope of services

Besides detection of cataracts & refractory disorders–expansion of services will include (i) screening school children & adults for low vision (ii) provision of Aids & devices (such an illuminator), high power lighting and other assistance to improve their vision (iii) provide continuity & sustainability of care through partnership with the government public health outposts; and (iii) regular follow-up –through frequent visits to the various locations by the newly obtained Mobile Van—equipped with diagnostic tools, vision improvement Aids & attention to other eye problems through referral to Eye Hospitals.

Structure of Management

Our outpost in program implementation in Rajasthan is Shared Vision Foundation (India). It is a legally registered—non-profit– NGO in the State of Rajasthan (Certificate No. 762-2010). It is governed by a Management Committee –a group of un-paid Community leaders –who have volunteered to serve as Board of Directors. The Foundation has a staff of 8 persons in program management and a field staff of 20 people who are stationed in the villages.