Eye Camp Surgery: An old tradition which should come to an end


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Eye Camp Surgery: An old tradition
which should come to an end

Prof. Altaf Hussain Rathore FFRCS
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Cataract is the commonest cause of blindness throughout the world. It is due to the opacity of the lenses of the eyes. It is estimated that 5 to 10 million people lose their eye sight in whole USA due to cataract. It is more common in elderly people and occurs in 15% of the population between 52 to 85 years of age. There are so many causes of this disease but old age and ultraviolet ray’s exposure and diabetes are considered to be commonest causes. In tropics and third world commonest causes is considered to be lack of vitamins and malnutrition and excessive sunlight especially ultraviolet rays and in the developed countries the major cause of cataract is diabetes mellitus.

Prof. Altaf Hussain Rathore

Surgery for the cataract is the most common of all the operations in the world. In States 1-2 mil people are operated every year for cataract Long ago in Indo Pakistan subcontinent there used to be a gypsy tribe called Rawal who used to travel from place to place and used to treat rather operate cataract patients. Their treatment was simple. They used a needle to push it into the anterior chamber of eye and with a sudden strong jerk they use to dislocate the lens to the periphery into vitreous of eye. Though the patient suddenly started seeing but later on used to get increased intraocular pressure with all complications of glaucoma. In the West cataract surgery started progressing since long. They started extracting opaque lenses under local anesthesia. With the advent of the aseptic techniques and effective antibiotics their success rate improved tremendously Lately cataract surgery became more safe by the introduction of operating microscope and implantation artificial lens. From 1930 to 1980 the whole lens along with whole capsule was removed by a half circle incision. It was called intra capsular lens extraction. Sutures were used to close the incision. Though Phaco emulsion technique i.e sucking out the lens material without disturbing the posterior capsule was introduced in 1967 but was not accepted widely till early eighties. It was called extra capsular lens extraction which was a great break through. Then came foldable artificial lenses which was introduced into the eye incision by a small up to 3 mm it made the job easier for the surgeon and safer for the patient.

Sensing that blindness due to cataract was very common in poor people in Indo-pak region the British missionaries became very active for its treatment and lot of British doctors eye surgeons and nurses (volunteers) came to Indo Pakistan and opened their hospitals for the treatment of disease of eye. Some of centers in Punjab like Taxila, Daska, Jalalpur jattan , Gojra and others places were quite popular. Beside these centers they used to hold eye camps in different places mostly in rural areas. It served two purposes. Treat the poor people and train the local doctors and staff in operation. I remember a local doctor in-charge of a government tehsil head quarter hospital with LSMF Qualification got training from a British surgeon during camp surgery and started regularly operating eye cases: But he could not train anybody even his son. So when retired he could not operate his cases due to old age diseases in his private hospital and used to get it operated by his young illiterate faithful trained waterman (mashki) . How long he could have continued this practice is anybody guess.

This practice of camp surgery continued after partition. Missionaries almost disappeared replaced by the local doctors, hospitals and philanthropist. Most of them used to conduct this camp surgery in some schools colleges, dispensaries or small hospital. Most of them never bothered to care for associated diseases like eye infection glaucoma hypertension diabetes etc. They just removed the lens. Patient had a bandage for weeks and the success rate was not much. Every person was give no 10 glasses. These eye camps were held by some not so rich philanthropist or by some hospital for their advertisement. Usually they used to be held in the months of march, April, October and November. Usually for three days, it used to be advertised by banners in the local areas. Big tent used to be erected people with their relatives came with their charpai or bedding or lay down on the floor. In some places chairs and beds even meals were given. Usually volunteer doctors were half trained surgeon or registrars or medical officer or demonstrators on some medical colleges. All the services were free for the patients. The patients were operated in some classroom or drawing room and sometime in operation theatre of a hospital. After the camp, more than often the patients did not know where to go for follow up. By the introduction of operating microscope auto reflector, Slit lamp biometry keratometer phacoemulsion machines, good antibiotics, better clinical Laboratory services and a bit improved eye surgeon skill and his assistant services things are changed. Individuals mostly have been replaced by organizations, rich philanthropists, religious parties but still some individuals play an important part for the treatment of eye diseases like late Soofi Barkat of salarwala ( Darul Ehsan) in district Faisalabad .

How they work I will give example of four (There might be more)

  1. Sufi Barkat Ali
  2. LRBT
  3. Dawah
  4. Foundation hospital Rajana and Chichawatni

Sufi Barkat was a retire captain from the British army and was a great pious and religious person rather a saint. He settled at his lands salarwala in Faisalabad district and named it as Darulehsan . He built a madrassah for religious education, a masque and small hospital for eye disease. His disciple came in thousands and donated huge amount for his project eye hospital. He use to and continued camp surgery in this hospital for two months in a year in October and March. The great Sofi himself shifted to another village Dalowal about 40 km from his original place but built a big eye hospital in his former place equipped by latest machines and gadgets for eye surgery. You can imagine from the progress of eye camp in this hospital held in the month of March 2017. There were 18 operating microscopes 36 operating tablet being used for 24 hours round the clock for 31 days. 56,000 cases of eye diseases were examined and 12000 operations for cataract were performed in this period. Patients just have to pay for the implants whose price ranged from Rs.250 to 40,000 each depending upon patient’s choice. Rest of 10 months the hospital remains locked.

LRBT is a big charitable NGO run most probably by foreign donations, which works mainly for the treatment of eye ailments. It is a well-organized organization, which works mostly in cities as well as in rural area. Its headquarter is in Karachi and has 55-60 primary and 18-20 secondary centers throughout the country. The Primary centers initially examined and select the cases for operation to be taken by transport to the regional secondary centers for operation. The secondary centers are located in their own hospitals with doctors, Surgeons, Technicians and all the gadgets for operation. They run their centers throughout the year. Everything for the patients is free except their meals and traveling expenses. They train their own technicians at Rawalpindi Lahore and Karachi centers for 3 to 12 months. At their big centers like Lahore their usual daily OPD is 1500 to 3000 and they operated 25 to 75 cases daily.

Religious organizations like Dawah select the site, place and expenses according to their sponsors. They can conduct the camp in some small hospital Clinic, School, College, some big residence even under a tent, I will quote the eye camp held by Dawah at Kamalia town Distt: Toba Tek Singh. It organized in a small clinic for three days in March 2017. Dawa always brings their equipment for operation from their central hospital at main center at Mureedke by ambulance. They hired one surgeon two technicians for first two days from Sialkot and from Multan on the third day. They paid them Rs.900/ per team per operation. The patients had to pay the cost of the lens depending upon the quality of his choice mentioned earlier) .In 3 days 560 patients were examined and 107 operation were performed.

Fourth example is the hospital like ours Foundation Hopital Rajana Distt: Toba Tek Singh and other in Chichawatni District Sahiwal. Both Run by a Foreign NGO Ucare Foundation and Pakistan International Foundation. They usually hold these camps in the beginning of April almost every year for three days. These hospital have latest equipment for surgery. Rajana hired a Surgeon from Gojra and Chichawatni from Sakhur (Sindh) paying them Rs.700/- per case Nothing was charged from the patients, even they were provided free meals. At Rajana 1230 patients, were examined and 200 surgeries were performed whereas at Chichawatni 1300 cases were examined and 250 were operated. No doubt camp of eye surgery has been a great blessing for the poor cataract patients who get their treatment at their door step. It is also a good place for training of our Doctors. But sudden influx of such a large number of patients does not give us a good quality of work. I have seen in one eye camp when the patients were standing in a queue in broad day light and doctor was quickly examining their eyes then and there with a torch and an ophthalmoscope in a sun shine. Usually proper investigations are not done. The standard of the most of the surgeon employed or volunteer doctor is not up to the mark. They believe in quantity rather than quality. They take three minutes to 30 minutes for each operation. We do not know the success rate because no proper follow up of the patients is done except in LRBT and some proper hospital camps. The training to the Doctor is like that of a technician because there is no master trainer. No renowned eye specialist or professor of ophthalmology is most often involved. World has advanced a lot by their research and we still are busy in our medieval camp surgery. We have very good eye hospital like Soofi Barkat Ali at Darul Ehsan, which can be converted to centers of excellence for this specialty; Instead of seasonal camps, they should do the regular surgery throughout the year. They should employ highly qualified and well reputed specialist instead of inadequately trained eye surgeons. People will come in great number how much far away the place is and God will give them same reward as they are getting from camp surgery. These centers will be the national pride and they will be good training places of eye surgeon and the patients will have much better services throughout the year. There will be less failure and complication rates. I suggest that this camp surgery should slowly be phased out and replaced by (charity) centers of excellence for eye surgery.