Nayana (means eye) is the name of a unique mobile eye care initiative for diabetic patients Supported by the World Diabetes Foundation — run by Dr Krishna R Murthy, Dr Praveen R Murthy, Dr K R Murthy and Subbakrishna Rao and a Joint Project of The Vittala International Institute of Ophthalmology, Prabha Eye Clinic and Research Center and The National Association for the Blind of Karnataka state of Bangalore in India. In fact, this is a great boon for the rural people living with diabetes retinopathy and its complications.
This unique mobile eye care initiative for diabetics is dedicated by the tireless efforts of 83 ophthalmologists, 225 physicians, 19 surgeons, 6 VR fellows and 9 mobile unit staffs who believe a difference can be made.
The diabetic retino-pathy dilemma
The treatment of diabetic retinopathy and its complications are usually run in urban centric care models. High patient drop outs are prevalent due to the cost and various socio economic factors. Camp based detection rates are high, but dropouts are also high which makes almost no difference when people do not or cannot avail further treatment facilities.
Expensive equipment, lack of manpower to handle them, inadequate number of trained physicians to provide skilled eye care are common reasons that promote the situation. Under this circumstance, the nature of the condition needs holistic and sustained care approach through a viable economic model. Moreover, when providing eye care for the poor, the main focus projects on cataract blindness. Diabetic retinopathy draws less attention of the ophthalmologists although a large number of populations have been suffering from the problem.
It is a matter of great concern that diabetes is a silent epidemic and the number of patients is escalating day by day. The increasing number of diabetes mellitus cases poses major health care challenges. Diabetes is also the leading cause of blindness worldwide.
Innovation in eye care for the diabetics in rural setup
To overcome these barriers, an innovative van was design all aluminum with special suspension with the help of Vortex Engineering and IIT Chennai. It contains special carry cases for equipment from Germany and Korea with provision of tele medicine link with DICOM 2 compatibility.
The van is equipped with modern and up to date instruments to offer advanced eye care to the rural people. The range of treatment facilities include from routine eye examination, fundoscopy to angiogram of the ocular vessels, laser treatment and tele medicine.
The start of the project
Three year ago when the van was first introduced in this area, retinopathy treatment was only been available at certain urban hospitals. This means travelling 200-300 Km to access such care, resulting in huge barrier for people who live in rural areas and semi-urban areas. However, now Karnataka has achieved impressive results after introducing a unique to bring the treatment out the patients.
Every month the van visits 23 locations across 13 districts catering to the needs of 18.31 million people. These locations consist of 8 eye hospitals/eye departments of larger hospitals, 3 Government hospitals and 11 other clinics.
“We have completed 375 field days. We see an average of 33-34 patients per location. This is the only van in India which is providing these kinds of facilities for the prevention and treatment of diabetes retinopathy”, said Dr. Shivaram, a senior ophthalmologist and coordinator of this mobile eye care van, based in Yalundar, Karnataka. He further said, “After the introduction of this van, 80 per cent of the people living with diabetes in rural areas have started getting treatment of diabetic retinopathy.”
Nayana is thus rekindling the light in many eyes, which would otherwise have become sightless.
People living with diabetes in this area have made a Diabetes Forum. This forum organises periodical meetings to address the problem of diabetes. Mr. Mahadev Appa, a patient of diabetes retinopathy and retired government employee, said, “I had been suffering from diabetes for the last 20 years. However, I had no idea about diabetes retinopathy till 2 years back when this van came to my village, B.R. Hills. Then I got myself checked and was diagnosed with diabetes retinopathy. I immediately started taking treatment and today my retinopathy problem is gone.” His 24 years old daughter Gayatri feels that her father has got a new lease of life.
Main goals of the project
The main objective of the project include to leverage the trained manpower already available in many locations of Karnataka, reducing the cost of diabetic retinopathy treatment, to increase compliance rates among patients for treatment, to provide diagnosis, treatment and management within a distance of 50 km of the patients’ residence, to improve clinical practice levels to global and uniform standards, to make the project sustainable; earn enough money to run itself, research and analysis, patient education.
The motto is — no patient shall go blind from diabetes for want of treatment or money in the project areas. In fact, this serves as a holistic approach of training of ophthalmologists.
Could Nayna be replicated?
Nayna has brought the eye care services especially for the diabetics to the doorsteps of the people who need it the most reducing the chance of drop outs. Along with providing the treatment, it has made people aware that they need the service, educated the patients and helped to develop a new insight among them. This model is very much needful in the context of any third world country. The people who run the project believe that this could be replicated anywhere.
There are people to help, finance and support if we can develop a sustainable model in our area of service. It is time to roll up our sleeves and work for the diabetics to help them see this beautiful world.
Dr Tareq Salahuddin, back from Bangalore, India
Source: The Daily Star, December 13, 2008