Rural Assam Reels under Poor Eye Care Services

According to a survey conducted by the World Health Organization, almost 40% population of Assam have some form of defective vision, while approximately 18.8% of the 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 elderly people suffer from cataract in rural Assam. 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 productivity of 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, 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 to an individual of urban Assam, as there have easy access to eye care services and eye products in urban areas. But it is not so for a person in rural Assam due to lack of accessible and affordable eye care services and eye products in rural areas. Most of the eye care services are urban-centric in Assam. There is neither private nor government eye care set-ups in rural Assam though more than 80% population of Assam live in rural areas. In the government PHCs or CHCs of rural Assam, there is lack of ophthalmologists. Even there is lack of optometrist to prescribe a pair of glasses in these PHCs and CHCs.

The people of rural Assam need to travel several kilometres to the nearest city/town to access eye care services. They need to travel to city/town with a relative, even for a routine eye check-up. They lose one day’s wage in the process, incur additional cost for travelling and food, and only then can 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 food expenditure as they have to travel to the city/town again to collect the ordered spectacle at a later date.

The whole process costs in the range of Rs 2,000 to 3,000, which is more than the total disposable income for most of the rural families. If they need cataract surgery, it costs another huge amount, which is unaffordable for most of rural people of Assam 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 of a city/town. The poor economic status of the rural people along with frequent socio-political unrest, poor connectivity and transportation facility in rural Assam – all these 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 strata. There is 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 have been 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 are treated properly in hygienic conditions, 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 Assam, as many district hospitals don’t have the facilities for cataract surgery. Therefore, many people of rural areas are still blind due to cataract. Of course, the State government is providing free spectacles to schoolchildren after screening refractive errors, 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 products at par with those available in cities/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 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 centers in the remote 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 as eye care service provider to the rural people of the State. Persons from the satellite basic eye care centres and/or eye care service provider 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 such areas, where they can provide free spectacles to the needy one, can detect patients requiring cataract surgery, and subsequently bring them to the eye centre with surgical facilities for surgery.

Dr Dharmakanta Kumbhakar

(The writer can be reached at drkdharmakanta@yahoo.com)