Nowak_subbed_Layout 1 01/09/2009 12:05 Page 12
International Health
Reaching Patients in the Himalayas – The Growth of ‘Eye Camps’
Rafal Nowak
Consultant, Eye Department, City Hospital, Poznan
Abstract
Nepal is a small, landlocked country draped along the greatest heights of the Himalayan mountains. Despite the fact that it is the major
tourist destination in the region, it remains a poor country with the burden of problems typical for underserved populations, including an
insufficient medical service system. Cataract continues to be the main cause of blindness in this country. However, in recent years there
has been a significant positive change in this situation: Nepal has managed to develop a specific, relatively efficient eye-care service
system whose highlights are well-organised eye hospitals, eye camps and the manual small-incision cataract surgery (SICS) technique of
cataract removal. The aim of this article is to describe these latest advances in the Nepalese eye-care system, with an emphasis on eye
camps as the particular manner of eye-care delivery to patients living in rural, mountainous areas.
Keywords
Eye camp, cataract surgery, small-incision cataract surgery (SICS), Nepal
Disclosure The author has no conflicts of interest to declare.
Received: 20 March 2009 Accepted: 2 April 2009
Correspondence: Rafal Nowak, Eye Department, City Hospital, ZOZ Poznan-Stare Miasto, ul. Szwajcarska 3, 61-285 Poznan, Poland. E: raf.nowak@wp.pl
Perched on the southern slopes of the Himalayan mountains, Nepal approach of inevitable death. Nevertheless, thanks to an appropriate
is a culturally, ethnically and geographically diverse country, making government health policy and enormous efforts by national (Nepal
it one of the major tourist destinations in the region. Eight of the Netra Jyoti Sangh) and international non-profit organisations, in
world’s 10 highest mountains, including Mount Everest, are within recent years Nepal has developed a specific, relatively efficient eye-
its territory. However, despite having such tourist attractions, it care service system whose highlights are well-organised eye
remains a poor country. The landlocked, rugged geography, lack of hospitals (see Table 1),
2
eye camps and the manual small-incision
tangible natural resources and miserable infrastructure, as well as cataract surgery (SICS) technique of cataract removal.
the long-running civil war, have been factors in stunting its
economic growth. The burden of problems typical for underserved The Nepalese eye-care system is based on stationary eye-care
populations, including an insufficient medical service system, posts as well as outreach programmes, frequently called ‘eye
continues to be a concern for the Nepalese government. camps’, providing eye care for patients who live in rural areas (see
Cataract continues to be the major cause of blindness in Nepal, and Figure 1). The structure of this health delivery system results from
most of those suffering from this disease will remain blind until the particular geographical conditions of Nepal
3
(see Figure 2). Most
they die. It is often said that when one gets old, the hair turns white, of the eye hospitals are located in the flat Terai region, while the
the eyes turn white and then death follows. majority of remote mountain villages remain without stationary
posts. Therefore, the system of eye camps has been put into place.
Cataract is the leading cause of blindness worldwide, with the
majority of cases occurring in developing nations. Of the 38 million There are two types of outreach eye-care delivery system: hospital-
cases of blindness worldwide (best visual acuity <20/400), an based and field-based. In the first system, screening camps are
estimated 16 million are caused by age-related cataracts. Moreover, arranged within a short distance from the base hospital. A team of
in Nepal alone the proportion of curable blindness resulting from ophthalmic assistants travels to a neighbouring village (typically a
cataracts is more than 80%.
1
two- to three-hour drive), where they perform routine eye
examinations. Minor ocular diseases are treated on the spot,
While in the western world eye-care professionals discuss the latest whereas complicated cases or those requiring surgery are referred
novelties in phacoemulsification and refractive surgery, such debates to the hospital. The second system entails surgical camps, which
are abstract in the poorest countries. There is a significant difference are always a big venture. Only a few are organised per year by each
in the patient’s attitude to cataract surgery between rich societies hospital participating in the programme due to the costs.
and underserved ones. In Europe, patients, aware of their disease,
come for cataract removal as soon as they experience mild blurring Before each camp, either screening or surgical, appropriate
of vision, while in Nepal old people treat losing sight as a sign of the reconnaissance must be carried out (population evaluation and
12 © TOUCH BRIEFINGS 2009