Prof. (Dr.) Dharmakanta Kumbhakar
(drkdharmakanta1@gmail.comm)
According to a survey conducted by the World Health Organisation, almost 40 percent of the population of Assam has some form of defective vision, while approximately 18.8 percent of the Indians suffering from cataracts are from Assam. The problem of defective vision is more prevalent among the people of rural Assam due to ignorance, poverty, and a lack of proper eye care. Most adults suffer from refractive errors, and most elderly people suffer from cataracts in rural Assam. Diabetes-related cataracts are also increasing among the rural people of the state.
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 productivity of adult rural people decreases, and families become poorer in these areas. Vitamin A deficiency-related blindness and refractive errors are more common among the children of rural Assam. Most of the students in these areas are behind in their studies due to refractive errors. Almost 80 percent of such defective vision can be corrected with two simple measures: a pair of glasses (43 percent) and relatively simple cataract surgery (33 percent). 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 in urban areas. 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 in such areas. Most of the state’s eye care services are urban-centric. There are neither private nor government-quality eye care set-ups in rural Assam, though more than 80 percent of the state’s population lives in rural areas. At the government primary health centres or community health centres in rural Assam, there is a lack of ophthalmologists. There is a lack of optometrists to prescribe a pair of glasses in these primary health centres and community health centres.
The people of rural Assam need to travel several kilometres to the nearest city or town to access eye care services. They need to travel to a city or town with a relative, even for a routine eye check-up. They lose one day’s wage in the process, incur additional costs for travel and food, and only then can they access eye care in a city or town, paying on par with the urban customers, which in most cases becomes unaffordable for them. If they need to procure glasses, it costs an additional amount. They lose another day’s wage and incur additional travel and food expenses 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 to Rs 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 rural people as they are either farmers or daily wage workers.
Unaffordable costs are a problem for the lower-income groups of rural Assam when it comes to private hospitals in the city or town. 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 to lead a productive life, irrespective of age, gender, geographic location, or economic stratus. 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 the NGOs bring the patients to the hospital for cataract surgery only after diagnosing them in their respective villages. After they are treated properly in hygienic conditions (intra-ocular lenses, surgery, and spectacles, all free of charge), 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 for refractive errors and providing free vitamin A supplements to children to prevent vitamin A deficiency-related blindness.
The state government must provide accessible and affordable eye care services and eye care products at par with those available in cities and towns to all the rural people of Assam 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 healthcare level. There should be at least one optometrist in every primary health centre in rural Assam to provide a pair of glasses free of charge to correct the refractive errors. The government, along with NGOs, must design a model to deliver basic eye care services to the people of the inaccessible, remote areas of rural Assam. They can establish satellite basic 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 of Assam. People from the satellite basic eye care centres and/or eye care service providers can go door to door in rural areas for screening eye problems and creating awareness about eye care. They can conduct eye check-up camps frequently in rural areas, where they can provide free spectacles to the needy, detect patients requiring cataract surgery, and subsequently bring them to the eye centre with surgical facilities for surgery.