Bihar Brief 2015

Dr. Anamika Tandon

I have known Lucy Mathen for nearly 15 years. In 2000, when she started Second Sight, she asked me if I would be willing to go with her to do children's eye work in India, I said a straight no! I was just not ready and knew that my knowledge and skills were both inadequate. And then earlier this year, when she asked me again, my response was just the opposite: I jumped at the opportunity. Well, without going into the details of this change of heart (or rather change of mind:-), I can say that it has been an absolute privilege to have visited Bihar as part of the SS team.

I first went in May this year and visited three SS partner hospital sites. Besides seeing lots of children with a variety of eye conditions, I operated on two children who had been blind due to cataracts in both eyes at Laxman Eye Hospital in Muzaffarpur. These were the first paediatric cases ever carried out at the LEH. The entire team felt triumphant when, the following day both children were able to see after years in darkness. When I returned in December the outreach team had brought in 4 more children with bilateral cataracts. One of the best moments was to operate on the second eye of a child whose first eye I had operated on in May! I am also full of praise for Dr Choudhry, the anaesthetist without whose help these operations couldn't have taken place. He simply accepted the challenge of this first time procedure at LEH and delivered wonderfully.

In Bihar there are now several government recognised optometry courses churning out graduates every year. But we found that they are not been being taught to accurately assess the vision of babies or children or to refract them. With uncorrected refractive errors being the commonest reason for blindness amongst the paediatric population in the developing world, this was a glaring gap in training. Imagine the children with uncorrected refractive errors who simply lived in a world with blurred/ foggy vision just because they didn't have the simple solution of wearing glasses to focus clearly. So an added emphasis this time was to train the optometrists in this essential skill. 3 qualified optometrists at LEH received intensive training and practice over 3 days by Rowena McNamara, a visiting UK Orthoptist and myself. I also trained ophthalmic assistants at another hospital in Northern Bihar.

On both these occasions, we went with the local outreach teams to the villages. The purpose was to screen children for cataracts but what we found to our surprise was the sheer number of children, mostly under 5s who had obvious eye signs and symptoms of Vitamin A deficiency including night blindness. I also saw several small children with irretrievable vision loss due to severe vitamin A deficiency and malnutrition. This is a genuine tragedy of gigantic proportions that is easily preventable. We are told that there are several programs in Bihar run by both government and non-government agencies to tackle this serious condition; some ophthalmologists even claim that vitamin a blindness is no longer a major problem because of these schemes .All I can say is that we come across it all the time in Bihar. We gave Vitamin A to the children in these villages there and then and spent a huge amount of time talking to parents. It was simply great to see their receptiveness and the intensity of their listening and their ability to absorb the message. The proof was that they all came back for the second day dose of Vitamin A.

What have I learnt from my Second Sight experience? That it is a bit of a myth that the poor and uneducated don't access treatment through ignorance. If we the clinicians take the time to go to the community and give them a clear message about their children's health, a programme will succeed. Time and again, I have been thrilled to see this on my Second Sight trips.

Dr. Anamika Tandon