Muzaffarpur Mission

by Paediatric Optometrist Rajula Karania.
March 2016

This is my amazing story of Laxman Eye Hospital in Bihar, a story of  immense humility, simplicity, generous hospitality, appreciation and love. One late friday afternoon in January whilst at work, an email in my inbox caught my eye. This email was to become the start of a truly fascinating journey for me.The email was from Lucy Mathen, an Ophthalmologist. The email was addressed to our Head of Department, and shared internally. It simply stated that she urgently needed an optometrist to go out to Bihar in India, to do some training/teaching. This got me thinking and slightly excited straightaway so I quickly made a note of the mobile no. On the train home, I kept thinking about this. I had been looking for an opportunity to do some voluntary work. I have a huge love for India and the fact that I can speak Hindi was an added advantage. However the state of Bihar was unknown to me, all I knew was that it was where my ancestors came from and that it was considered one of the less safe parts of India. Nevertheless something about the message made me respond impulsively.

I made contact with Lucy that weekend and she filled me in on the trip and the background to the project. In essence what I understood was that a new paediatric unit was being set up at the Laxman Eye hospital and an optometrist was needed to go train the local optometrist trainees in, specifically, vision testing and refraction in children. I also got to speak to Dr Anamika a paediatric consultant from Leicester who had on her last trip there in Dec 2015, briefly introduced them to the basics of retinoscopy. I remember thinking that this was a golden opportunity not to be missed. It was a chance for me to give back to the community what I had learnt and gained in experience over the years as a hospital paediatric specialist optometrist. So despite my preconceived ideas of Bihar, I took on the challenge and I was on my way to Muzaffarpur. 
Fast forwarding to Laxman Eye Hospital, which was to be my place of work for the next week; well what can I say, I received a very warm welcome by these complete strangers which was very overwhelming. I got introduced to my 'Team of Three' trainees - Ravi, Juli and Babul, who also worked as scrub nurses and health care assistants in the operating theatre.

For me the challenge was to teach all of them how to refract young children. Retinoscopy is a very difficult skill to teach - the person demonstrating cannot see what the trainee can see and vice versa. In addition I was teaching them in Hindi, which though I speak fluently is not my mother tongue. Needless to say translating some of the ophthalmic terminology in a different language was quite a challenge for me!

During the time I  spent there, what struck me the most was the incredible patience and appreciation of both the staff and all the patients at LEH. The little children were just amazing, even the two and three year olds would come into the room alone without their parents and sit still for what seemed  like hours without moving at all. I can honestly say that I did not hear a single child cry when instilling drops nor during the examination. It was really sad to see so many young children coming in off the street with really poor vision, mostly due to uncorrected refractive errors, but even more heartbreaking to see virtually blind babies and children from various eye conditions ranging from congenital cataracts to iris and retinal colobomas, nystagmus, corneal ulcers, and night blindness from vit A deficiency.

With hindsight, a week was just not long enough. Nevertheless I am confident that the task I undertook was fruitful. I believe I have sown the seeds and by the end of my week long stay, my team of three, Ravi Juli and Babul had mastered cycloplegic refractions pretty well and were also demonstrating good vision taking skills previously shown to them by Rowena McNamarra, an Orthoptist. I am certain that all three will continue to practice and take it forward from here. We saw over 70 children during that week, many of whom were prescribed glasses. I am very grateful to Second Sight for giving me this platform to share my knowledge and skills and  I feel especially proud to have been the first optometrist to be involved in the inception of this new paediatric unit. While I was there, I also helped Lucy to develop a new protocol for a smoother patient journey through OPD.  

In conclusion I would really love to go back again as I feel my work there is incomplete. There are so many many children walking around in Bihar practically blind simply because they have no access to eyecare and glasses. I am sure this new paediatric clinic at Laxman Eye Hospital will make a  huge difference. I believe this journey was 'meant to be 'as 4 to 5 months earlier someone had  literally pushed a book under my nose to read. The title of the book was 'A Runaway Goat' and the author Lucy Mathen. I didn't get to read it at the time and it wasn't until much later when i was planning my trip that I saw the cover page and title of this book on the Second Sight website and then it all fell into place.