Poor Eye Care Services in Rural Assam
Dr.DharmakantaKumbhakar
Accordingto a survey conducted bythe World Health Organisation, almost 40% population of Assam have some form of defective visionand approximately 18.8% of Indians suffering from cataracts belong to Assam. The problem of defective vision is more among the people of rural Assam due to ignorance, poverty and lack of eye care. Most of the adult people suffer from refractive errors and most of the elder people suffer from cataract in rural Assam. The diabetes related cataract is also increasing among the rural people of Assam.
Agriculture related corneal injury followed by corneal ulceration, corneal opacity and blindness is more common amongst the farmers of rural Assam. Due to defective vision, the productivityof adult rural people decreases and the families become poorer. Vitamin A deficiency-related blindness and refractive errors are more amongst the rural children. Most of the rural students are backward in their studies due to refractive errors.Almost 80% of such defective vision can be corrected with two simple measures – a pair of glasses (43%) and a relatively simple cataract surgery (33%).When there is global initiative for elimination of avoidable blindness by the year 2020, rural Assam has yet the lowest access to basic eye care services.
Getting an eye check-up, a pair of glasses and cataract surgery may be easy to anindividual of urban Assam, as there have easy access to eye care services and eye products in urban areas. But, it doesn't remain so for a person in rural Assam. Most of the eye care services are urban centric in Assam. There is neither private eye care set ups nor government eye care set ups in rural Assam, though more than 80 percent population of Assam live in rural areas. In the government PHCs or CHCs of rural Assam, there is serious lack of ophthalmologists. Even there is a lack of optometrists to prescribe a pair of glasses in these PHCs and CHCs.
The people of rural Assamneed to travel several kilometres to city/town to access eye care services.They lose one day's wage in the process, incur additional travelling and costs of food, and then access eye care in city/town, paying at par with the urban customers which in most cases become unaffordable to them. If they need to procure glasses, it costs an additional high amount. They lose another day's wage; incur additional travelling and costs of food as they have to travel to the city/town again to collect the ordered spectacle on other date. The whole process costs are in the range of INR 2000 to 3000, which is more than the total disposable income for most rural families. If they need cataract surgery, it costsanother huge amount, which is unaffordable for most of the poor rural people of Assam.
Every person has the right to see things clearly and to lead a productive life, irrespective of age, gender, geographic location or economic strata. There are a large underserved population in rural Assam without any access to eye care services. There are many people in rural Assam with very low vision who have not taken any corrective measures. At present, rural eye camps under the 'National programme for control of blindness" in Assam are banned. The government proposed to adopt the 'Madurai pattern of eye care', where the NGOs bring the patients to the hospital for cataract surgery only after diagnosing them in their respective villages. After they have been treated properly in hygienic conditions (with free intra ocular lenses, free surgery and free spectacles) they are left back in their locations. It is a better system to give better eye care to the needy rural people of Assam. But, the system is not running properly in Assam, as many district hospitals in Assam don't have the facilities for cataract surgery. Therefore, many people of rural Assam are still blind due to cataract.
The government must provide accessible and affordable eye care services and eye products at par with those available in cities/townsto all the rural people of Assam irrespective of age, gender, geographic location or economic strata, so that they can correct their defective vision and lead a productive life. For this, the government must provide basic eye care facilities at Primary health care level. At least one optometrist should be in the PHCs of rural Assam to provide a pair of glasses free to correct the refractive errors.
The Government, along with NGOs, must design a model to deliver basic eye care services to the most underserved and inaccessible remote areas of rural Assam. They can establish satellite basic eye care centres in remote areas of rural Assam.