Sight for Sore Eyes

AASHA MEHREEN AMIN

Islamia Eye Hospital on a Thursday morning is teeming with people. All kinds of people -- babies on their mothers hips, old women being led by their sons or daughters, young men, teenagers, middle class, working class -- every group seems to be represented. They come from all over the country. Some of them are here for the first time; others have been coming for a while. Most of them are here to get back their sight or to clear their blurry vision.

It all seems a bit chaotic at first but a closer look reveals that everything is going on schedule. New patients go into ticket rooms where they can buy a ticket for only Tk. 20 with which they can get all their eye exams and preliminary treatment. The ticket is valid for a whole month and covers as many visits as needed within that time. There are separate ticket rooms for men and women. With the ticket the patients go into the huge consulting room where 14 doctors are sitting to give medical attention. A serial number is given for each ticket and the patients wait in the waiting area until their numbers are called. Each doctor sees a batch of 10 patients at a time, so a total of 140 patients are selected at a time following which the remaining batches are seen. Those who require special attention are referred to one of the many eye specialists on the other side of the building. Thus everyone present gets to see a doctor, the waiting period is not long and there is no pushing and shoving to get ahead of another patient. The process takes place so smoothly that by 12 p.m. the crowd of 500 to 700 patients, who come every day, is almost completely thinned out.

A VIP room at the Islamia Eye Hospital. Rich patients can also benefit from the hospital's modern, sophisticated services and state-of-the-art facilities.

The hospital has a team of 40 highly skilled doctors, 35 of them are surgeons backed by dedicated nurses and paramedics to see to it that patients are attended to promptly in a friendly, caring environment. Patients are seen between 8 a.m. to 2 p.m.

The hospital's Fast Track Centre caters to patients who can pay for the Tk. 200 ticket fee and benefit by cutting down on the waiting period. Dr. M. A. Majid Khan, a senior consultant who joined Islamia as early as 1979, says that at this centre the services i.e. eye examination, prescription, spectacles, are the same as the regular outdoor patient services, only they do not have to wait.

At the Islamia Eye Hospital no one is turned away.

But perhaps the most remarkable feature of this 40 plus year old institution is that no one is turned away. No matter what the person's financial position, no matter how complicated the disease is, the patient will be attended to by extremely qualified doctors and will be entitled to the best and most advanced treatment. Sounds a bit too good to be true but the hospital has so far lived up to its philosophy of providing the best quality eye care to both the rich and the poor. Of course a vast majority of the patients are in fact extremely poor but the hospital's administrative advisor Zaida Ispahani, insists that the services and equipment are state of the art and as good as those provided by hospitals abroad. “We strongly encourage the rich to come for treatment because every kind of eye treatment is available and there is no need for patients to go abroad for treatment.”

It gets quite crowded at Islamia in the mornings but an efficient system ensures that all patients are attended to.

This includes Cornea and anterior segment, Glaucoma, Retina-vitreous, Orbit and eye plastic surgery, laser, Cataract surgery including Phaco with Foldable/ Non Foldable Intra Ocular Lens (IOL) surgery. The hospital is also working with Shandhani for cornea replacement although there is a huge dearth of cornea in the country, says Zaida. Specialised paediatric services are also provided for children with eye problems.

While the services and care are exactly the same, well off patients get better amenities as they have to pay more. A bed at the general ward costs Tk 125 a day including food while cabins for richer patients cost from Tk. 300 to Tk. 2,500 a day (also with food). There are 24 air-conditioned cabins with TV and nurse services. Some of the cabins are being renovated to make them more attractive to rich patients. Such efforts are geared towards boosting the hospital's 'cross subsidy' programme which channels funds earned from such services to sponsor poor patients. “Sometimes patients come to us with no money at all,” says Prof Khan M. A. Manzur, the hospital's Director General, “but they require surgery very urgently so we use the money from our 'poor fund'.“ To make sure candidates of such free treatment are genuine the hospital's counselling department carefully screens the patients to determine just how needy they are so that undue advantage is not taken.

While the running costs of the hospital are managed through the revenue it generates through ticket fees, funds are still needed in order to give more free treatment and to improve the hospital's infrastructure which is quite old and in need of renovation. Some funds come from the trustees and personal donations from their friends. But the support from the community, says Zaida Ispahani, has been spectacular. Just recently Standard Chartered Bank has funded a fully equipped highly sophisticated operation theatre. In addition the Bank has financed a 20 bed ward for children. Organisations such as Sight Savers and Orbis have also extended their assistance to the hospital. “Our margin of profit is very low so we encourage donations in whatever form from individuals and organisations because it will allow us to sponsor more patients who are extremely poor,” says Zaida.

With the Tk. 20 ticket a patient can consult with the eye doctor as many times as required for a whole month.

Cataracts -- Blindness that is Avoidable

At the newly built Children's Ward donated by Standard Chartered two and a half year old Likhon from Meherpur sits on a bed with a patch on his left eye. He is recuperating from a cataract operation that will enable him to see. Both his eyes have been operated upon at the hospital as when cataract develops in one eye, the 'good' eye too, gets affected and has to be treated before it is too late. Such details are a little hazy for Likhon's mother but she expresses her gratefulness at the treatment her child is getting especially since a messed up operation at another hospital had almost destroyed his sight.

Cataract among small children is a common cause of blindness in Bangladesh but surgery can give them their sight.

The beds around Likhon's also have other little patients. A fifteen month old baby tosses his head to and fro as his mother tries to calm him. His strangely flat head is a result of a badly handled delivery says his young mother, one that probably also affected his sight. He too has had a cataract removed and presumably he will be able to see. Next to Likhon's bed is four year old Chanchal wearing dark glasses and quietly eating his khichuri. He too has had a cataract removed and can now see clearly.

At the Fast Track Centre patients who can pay for the Tk. 200 ticket fee can benefit by cutting down on the waiting period.

This year under the new management, Islamia's mission is targeted towards performing as many cataract operations as possible to help reduce avoidable blindness. Eighty to eighty-five percent of the one lakh ten thousand people who go blind each year is caused by cataract, says Prof Manzur. A thin film accumulates and covers the surface of the pupil distorting vision and eventually causing blindness. “The percentage of success of cataract surgery is nearly 98%,” he says, adding that blindness that is caused only by cataract is called 'avoidable blindness' and can be treated with surgery. The surgery is fairly simple but the consequences are as dramatic as the difference between seeing and not seeing. Early detection of any eye disease is crucial for successful treatment and is true for cataracts as well, says Prof Monzur.

Dr. Khan M.A. Manzur the hospital's Director General and consultant says that there are several factors that lead to cataract of the eye, a common disease that causes avoidable blindness.

There are several factors that lead to people developing cataracts. The possibility of being affected by cataract can start as early as during the cell division of the foetus, explains Prof Monzur. “If there is some abnormality in the cell division when the baby is developing in the stomach, it may lead to the baby getting cataract of the eye.” The health of a pregnant woman is crucial in this regard, he adds, as cataracts of very small children can be caused by medical drugs taken while pregnant, having high blood pressure or getting German Measles or rubella during pregnancy, diabetes and so on. Poor nutrition of the pregnant woman and foetal distress during delivery are also factors. Cataracts are also hereditary, says Prof Manzur and many people get cataracts because their fathers, mothers or grandparents had diabetes, which in turn causes cataract of the eye. Congenital cataracts may manifest early in life. Other reasons he lists include injury of the eye (a hit in the eye with a golf ball for example), tumours, skin disease like eczema, rheumatoid arthritis and taking of some steroids.

Thus Standard Chartered's 'Seeing is Believing' global campaign which includes building the new Standard Chartered Operation Theatre and Children's Ward could not have come at a better time. “It has greatly helped to expand our capacity, we now can do 60 cataract operations a day,” says Zaida. “Moreover, the Bank has appointed a Project Director who has trained for a month in India to help us run this cataract project.” The Bank and some NGOs will be collaborating with the hospitals so that the operations can be done at cost price.

The Standard Chartered's Children's Ward at the Islamia Eye Hospital is a spacious area with colourful wall paintings to cheer the child patients.

The other aspects of Standard Chartered's initiative are to raise funds to restore sight to 28,000 people and Primary Eye Care training to nearly 7,000 health workers in Bangladesh through Sight Savers International. “We were looking for a cause that was simple and could have a direct positive impact on people's lives,” says the Bank's C.E.O. in Bangladesh, David Fletcher. “The Operation Theatre and Children's Ward in Islamia Eye Hospital is an outcome of that commitment. It will generate long-term sustainable benefits instead of being a one-off charity.” Fletcher adds that the Bank's staff members in Bangladesh have worked one day free to raise funds that will be used to restore sight to 150 children to make the Bank's 150th anniversary.

Fletcher says that in the future Standard Chartered will continue to support the Operations Theatre and Children's Ward. This is in line with the Bank's commitment “to give back to the communities where it does business and where its employees live with their families”.

A nurse checks for cataracts at the outdoor patient section.

In line with this year's mission the hospital's outdoor patient section places more importance on cataract patients. Which is why the attending nurse at the waiting room checks for cataracts when she is checking the patients and groups them with other cataract patients who are treated on a priority basis. “There is such a huge backlog of cataract patients who need to be treated immediately,” says Zaida.

Her vision has become blurry but the hospital gives her hope of clearer, brighter days.

Although cataracts have been given special emphasis this year, other more complicated procedures are constantly being done at Islamia. Diseases of the retina, for example, are treated at the Retina Department. The operations of the retina require sophisticated expertise and equipment. Dr. Ansarul Huq, a senior consultant of the hospital and working here since 1982, says that patients from all over Bangladesh are referred to the Islamia Eye Hospital for problems related to the retina. Tiny holes or tears in the retina or retina detachment can lead to blindness if not treated early, says Dr. Huq. Diabetes, head injuries and cataract surgery are some of the causes.

The brand new Standard Chartered Operation Theatre will allow the hospital to carry out as many as 60 operations a day.

he founder of Islamia Eye Hospital M. A. Ispahani wanted to build an institution that would provide the best possible eye care for the entire community, regardless of social distinctions. It started as a dispensary and developed into an eye hospital in 1960. At the time there were no specialist hospitals and all ailments were treated at the general hospitals. The Islamia Eye Hospital was a big undertaking from the private sector -- it had around 250 beds, the same number as Dhaka Medical College Hospital (DMCH). Now, after over 40 years

After the serial number is called the attending doctor examines the patient's eye and gives a prescription for spectacles or medication if necessary or refers him to a specialist at the hospital.

the importance of such a hospital is even greater. The number of patients is astronomically higher with a larger proportion of senior citizens (due to longer life span) and children -- both groups being vulnerable to eye disease due to various factors. “It is in our national interest to develop this hospital,” says Dr. Manzur. The new management, says its advisor, is to restore the founder's dream 'to help restore sight' and make this hospital a modern eye care provider 'where no one is turned away'. So far they seem to be on the right track.