Prof. (Dr) Dharmakanta Kumbhakar
A survey by the World Health Organization (WHO) states that almost 40 per cent of the population of Assam have some form of defective vision, while approximately 18.8 per cent of Indians suffering from cataracts are from Assam. The problem of defective vision is more prevalent among the people in rural Assam due to ignorance, poverty and lack of proper eye care. Most adults suffer from refractive errors, and most of the elderly people suffer from cataracts in rural Assam. Diabetes-related cataracts are also increasing among the rural people. Agriculture-related corneal injury followed by corneal ulceration, corneal opacity and blindness is more common amongst the farmers.
Due to defective vision, the productivity of the adult rural people decreases, and the families become poorer. Vitamin A deficiency-related blindness and refractive errors are more common among the children in rural Assam. Most of the students of these areas are poor in their studies due to refractive errors. Almost 80 per cent of such defective vision can be corrected with two simple measures – a pair of glasses (43 per cent) and a relatively simple cataract surgery (33 per cent). There is a global initiative for the elimination of avoidable blindness, yet rural Assam has the lowest access to basic eye care services.
Getting an eye check-up, a pair of glasses and cataract surgery may be easy for an individual in urban Assam, as there is easy access to eye care services and eye care products. But it is not so for a person in a rural area due to the lack of accessible and affordable eye care services and eye care products. Most of the state’s eye care services are urban-centric. There are neither private nor government-quality eye care setups in rural Assam, though more than 80 per cent of the state’s population live in rural areas. At the government primary health centres or community health centres in rural Assam, there is a lack of ophthalmologists. There is also a lack of optometrists to prescribe a pair of glasses in these primary health centres and community health centres.
People of rural Assam need to travel several kilometres to the nearest city or town to access eye care services. They need to travel there with a relative, even for a routine eye check-up. They lose one day’s wage in the process, incur additional costs for travelling and food, and only then can access eye care, paying at par with the urban customers, which, in most cases, becomes unaffordable for them. If they need to procure glasses, it costs an additional high amount. They lose another day’s wage and incur additional travelling and food expenditure as they have to travel to the city or town again to collect the ordered spectacles at a later date. The whole process costs in the range of Rs 3,000-4,000, which is more than the total disposable income for most rural families. If they need cataract surgery, it costs another huge amount, which is unaffordable for most of the rural people, as they are either farmers or daily wage workers.
Unaffordable costs are a problem for the lower-income groups in rural Assam when it comes to private hospitals in the urban areas. The poor economic status of the rural people, frequent socio-political unrest, poor connectivity and dismal transportation facilities in rural Assam all compound the problem.
Every person has the right to see things clearly and lead a productive life irrespective of age, gender, geographic location or economic status. There is a large underserved population in rural Assam without any access to eye care services. There are many people in such areas with very low vision who have not taken any corrective measures. At present, rural eye camps under the National Programme for Control of Blindness have been banned in Assam. The government proposed to adopt the ‘Madurai pattern’ of eye care, where NGOs bring patients to the hospitals for cataract surgery only after diagnosing them in their respective villages. After they are treated properly in hygienic conditions (intraocular lenses, surgery and spectacles, all free of cost), they are taken back to 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 our state, as many district hospitals do not have the facilities for cataract surgery. Consequently, many people in rural areas are still blind due to cataracts. Of course, the state government is providing free spectacles to the schoolchildren after screening refractive errors and providing free vitamin A supplements to children to prevent vitamin A deficiency-related blindness.
The Assam Government must provide accessible and affordable eye care services and eye care products at par with those available in urban areas to all the rural people of the state so that they can correct their defective vision and lead a productive life. For this, the government must provide basic eye care facilities at the primary health care level. There should be at least one optometrist in every primary health centre in rural Assam to provide a pair of glasses free of cost to correct the refractive errors. The government, along with NGOs, must design a model to deliver basic eye care services to the people in the inaccessible remote areas. They can establish basic satellite eye care centres in such areas. The district headquarters must have an eye centre with surgical facilities which should be connected with the satellite centres providing basic eye care in the adjoining rural areas. Moreover, the government can appoint some health agencies to provide eye care services to the rural people. People from the satellite basic eye care centres or eye care service providers can go door to door in rural areas for screening eye problems and create awareness about eye care. They can conduct eye check-up camps frequently in rural areas, where they can provide free spectacles to the needy ones and detect patients requiring cataract surgery and subsequently bring them to the eye centre with surgical facilities for surgery.
(The writer can be reached at drkdharmakanta1@gmail.com.)