The camp crisis - Part One

Cataract development is a natural phenomenon which cannot be prevented. Natural clear lens looses its clarity gradually and the vision is blurred. If cataract is mature patient is almost blind due to cataract.  Fortunately it is curable. At some age, normally after sixty years, people will get cataract. There is no medical treatment, only surgical treatment is available for the present. The affected lens is to be removed & Intra Ocular Lens (IOL) is to be implanted during surgery itself. This is a simple operation which takes less than ten minutes including preparation.

Though the surgery is simple it is costly in private nursing homes. It may cost Rs. 25 to 30 thousand. Overheads are the main cause for the increased cost of surgery. People are prepared to spend hefty sum to satisfy their ego. We are cataract people having completed more than 28,500 IOL surgeries at our rural cataract surgery mega camps. More than 98 % of the people get very good vision in our camps. We asses the power of the lens through Keratometry & A- Scan and insert the exact power lens as measured. So the results are consistently good. We correct distant vision only and they must use spectacles for near vision.

The rural people who cannot afford costly surgery in nursing homes remain cataract blind. For such poor people Sri Vivekananda Sevashrama conducts mega cataract surgery camps in Govt. or other hospitals nearer their homes. These people will be eagerly awaiting for such camps. The out patient may exceed 1000 in many camps and 300 to 400 patients are selected for surgery in a two day camp. It is a herculean task to manage huge crowds. Only mature cases of old people are selected and immature cases are rejected. We do not reject complicated cases. They are given red cards and their condition of the eyes are explained to them. If they accept they are operated for cataract. Hyper mature cataract may cause pain, it is inevitable that the cataract is to be removed early whether the patients regain vision or not.

The patients are not charged anything for the surgery and medicines, everything is totally free. They are fed during the surgery camp. Their only expense is for traveling from their village to the camp site and back. Many poor do not afford even this small expense. Such is the condition of the rural poor even today after 65 years of independence. The condition of the poor is pathetic, It is these people we want to serve. We have chosen remote villages and towns to conduct cataract surgery mega camps. Normally the villagers do not come to camps conducted at places 20 KM or beyond. It must be as near the place of their residence and must have good bus communication. It is understandable, for many coming to the camps by walk. Old people, their eyesight is poor due to cataract, undernourished and weak, walking long distances is a miserable sight. We cannot afford to provide transport. Some day we may have to think of providing transport to and from the camps.We have to test their blood sugar level and the blood pressure.they have to be within the maximum permitted limits otherwise they will have to be brought within limits by medication during the camp or the must be advised to take suitable medicine and attend the next camp. It is easy to say come to the next camp. We do not know when the next camp will be. It may be next year and to remain blind for the whole year will be miserable. We try to manage the condition as for  as possible and in case the it is beyond the permissible limits we have no alternative than to send them back with a heavy heart knowing fully well that they may not be alive and may never return back to the next camp.

We understand the problem, but we are helpless. We concentrate on the surgeries and connected problems with surgery. Patient care is the responsibility of the local sponsors. Both the sponsors and the surgical team work with limited finance. We have our own limits and we have to work with what money we have collected for the camp, almost hand to mouth existence. Our concentration is on the quality of the surgery and of course maximum number of cataract blind should receive good eye sight. When we have to conduct 300 to 400 surgeries in a two day camp, it is pressure for every one including doctors. We do not compromise on quality for the sake of numbers, it is a continuous chain from selection of patients to surgery and beyond, till they are discharged the next day morning. They are old, they are malnourished and weak, vision is poor, hard of hearing, walk with sticks for support, feel difficulty in sitting  on the floor and getting up. Wherever possible we provide chairs, we try to reduce their misery to the extent possible, still we have to do more to make them comfortable, for invalids we do provide wheel chairs or carry them to the theater and back. It is inevitable that patients have to wait for long hours or even days to get their turn. Very old women, invalids and children are given priority attention. When we screen 1000 and more patients, select 400 and odd for IOL cataract surgery it is inevitable that they have to move in queue from beginning to end. Four doctors will be continuously doing surgery for hours without rest. They take break for lunch. We have to do a minimum of 200 surgeries per day to complete 400 surgeries in two day camp. Most of the doctors who attend mega camps are gifted, exhibit extraordinary skill and complete the surgery well within five minutes, completing 12 to 15 surgeries per hour continuous;y. Not all can do it, it is the gift of God for a very few surgeons who are service minded. God has selected some of the best doctors to serve at our camps. Not only they must be fast  but also they have to maintain the quality of surgery till the last patient.

How about complications? We take at most care for preparation of operation theater. Volunteers of Sevashrama does this work with care, we may take the help of staff of the hospital when available. We look after sterilization of all instruments and other materials that goes inside O.T. We prefer to use disposable Needles and syringes. We sterilize all the instruments continuously after use for each patient, this includes eye towels & other dresses. Absolute cleanliness is required in O.T. Eye is a very delicate organ. Chances of infection & loss of sight is the prize we may have to pay if we are careless. Infection within OT is one thing and infection contacted outside after discharge is another. We take utmost care that infection do not occur within OT. Most of the infection reported is from outside after discharge. The patients and their relatives ignore early signs like pain and watering in the operated eye. They do some medication themselves and when things aggravate they complain that things have gone wrong at the camp. They do not accept that they have not followed instruction and instilled eye drops as per advice. By the time the patient contacts us it will be late and we cannot save their eyesight. Only alternative is to evisceration & removing the eye ball to reduce pain and to prevent further spread of infection. The blame is squarely put on the operating people and eye camp management. There are petty politicians and TV reporters who wants to create news and blowup small things out of proportion. They demand compensation from those who organise camps with a noble intention of serving the sightless people for regaining vision. Organisations must be protected from these insane people who fail to understand reason. Nobody can assure success of each and every surgery that is carriedout not only in camps but also in most sophisticated hospitals. Only to remove cataract is the job of the surgeon but to bring back sight is the handy work of GOD alone, it is beyond human effort.

Sri Vivekananda Sevashrama conducts the mega camps on Friday's & Saturdays. Screening is done on Thursday Or earlier. Blood pressure is to be under control, 170/95. We can use medication to control BP during the camp if it is near about the prescribed maximum. Normally urine sugar is tested in Govt. hospitals. It is not easy to control sugar by medication at the time of the camp. Sugar patients are sent back. Most of the time the patients do not know that they have high sugar levels. Many times they do not know anything about BP. They are poor and will not try to control BP & sugar by taking medication. At any cost they need good eyesight. We may have to take the risk and conduct surgery, if it is very high we have no alternative than to send them back and ask them to attend the next camp after medication to control these vital parameters.  

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