Initiative

Vision on Wheels

Shankara Nethralaya's mobile van and spectacle dispensing unit is helping rural people to have a better vision, finds out Nayantara Som.

Around 70 per cent of the Indian population lives in villages, but the extent to which the Indian healthcare has penetrated this section is questionable. In fact, the World Health Organisation (WHO) estimates reveal that 90 per cent of the world's blind people live in developing countries, of which seven million are each in India and China. Every five seconds, an adult is known to go blind, while a child goes blind every minute. Globally, there are 37 million people who are visually impaired, about 124 million more with significant loss of vision, of which 75 per cent of blindness is avoidable, either preventable or treatable.

Estimates point out that the number of blind and visually impaired will double by 2020, unless action is taken. An answer is here. The Shankara Nethralaya Tele-ophthalmology Programme (SNTOP) comes as a blessing for those suffering from eye-related ailments and for whom treatment is a distant dream. What is unique about SNTOP is its mobile van units that constantly move in the rural districts of Tamil Nadu, Andhra Pradesh and Karnataka

Displays to See Better

"ISRO gifted us a large van along with a dish antenna and the relevant software and hardware to connect the unit via a satellite connection" - Dr Lingam Gopal Chairman Elect Shankara Nethralaya, Chennai

The first mobile unit was initiated by Shankara Nethralaya along with Indian Space Research Organisation (ISRO), Bangalore in the small districts of Tamil Nadu. The mobile tele-ophthalmology and spectacle dispensing unit is aimed at providing urban facilities to rural areas.

Dr Lingam Gopal, Chairman Elect, Shankara Nethralaya, Chennai, says, "ISRO gifted us a large van along with a dish antenna and the relevant software and hardware to connect the unit via a satellite connection." The van was self-contained, and the satellite connection helped us take a second opinion of the experts at the hospital.

As early as January 2001, house trials were conducted through a LAN connection, connecting ophthalmic and video-conferencing equipment between the two campuses of Shankara Nethralaya and Jagatkurusrichandrasaraswatinethral Niyalam (less than a kilometre from Shankara Nethralaya). Around 100 patients were screened through this concept. These trials were an impetus for setting up a Tele-ophthalmology Consultation Centre at Bangalore, supported by ISRO and connected via three ISDN lines to the centre at Chennai. Around 300 tele-opthalmology consultations were conducted by May 2003. In the long-run, the experience gained was an incentive for the Institute to design a mobile tele-ophthalmology unit to link rural areas to the hospital. The house trials helped realise the many deficits in technology with the mobile van. High resolution cameras were one. The cameras that came with JPEG quality images had a tendency to produce low-quality pictures and were not sufficient for such a unit. The deficiencies were rectified and thus began Shankara Nethralaya's investments in high quality technology.

Patients line up to register at one of the camps

Gradually, with the concept becoming popular, a second mobile unit was added in Andhra Pradesh in collaboration with the World Diabetic Foundation (WDF) and then a third unit alongwith Bangalore-based Essilor India in Karnataka. Recently, an MoU inked between Shankara Nethralaya and MS Swaminathan Research Foundation (MSSRF), Chennai, helped kickstart the project in Southern Tamil Nadu.

Shankara Nethralaya bears the entire cost of the project. The first pilot project in collaboration with ISRO cost Rs 60-70 lakh, while the other three projects (including the one with MSSRF) cost close to Rs 41 lakh.

Constant Care

SNTOP conducts comprehensive eye examinations in rural areas at the patient's doorstep with spectacle dispensing units, eye screening for children and diabetic retinopathy screening camps. Says Dr SS Badrinath, President and Chairman, Medical Research Foundation, Shankara Nethralaya, "The mobile van unit covers an area of 150 kilometres in Karnataka and Northern parts of Tamil Nadu. In Tamil Nadu alone, we cover six districts and cater to 70 lakh people."

Everyday, the mobile unit visits one MSSRF, Village Resource Centre (VRC) and Village Knowledge Centre (VKS) at Chidambara, Nagapattinam, Thiruvaiyaru, Annavasal, Sembatti and Thangachchimadam in consultation with Jamshedji Tata National Virtual Academy for Rural Prosperity. All the selected districts are within a radius of 300 kms from Chennai. The selection of these villages is to help the mobile unit quickly return to Chennai in case of an emergency.

Each van is manned by two optometrists and four social workers. "We screen around 120-150 patients each day, of which 20-25 patients with complex problems would be looked at by an opthalmologist at Shankara Nethralaya through the ISRO network," says Badrinath. Murali V, Manager, Electronic Communication, Shankara Nethralaya, says, "Our consultants are available from eight in the morning to 12 noon for one district and resume from two in the afternoon for an eye camp situated in another district." The camps work from Tuesday to Sunday. Further, there is an everyday awareness camps conducted between seven and eight in the night.

Typically, a day at an eye camp commences at eight in the morning. With support from camp sponsors, local volunteers (mostly students) record the patient's details and registered patients are handed out identity cards after which they are attended to by a Shankara Nethralaya social worker. Vision charts such as E-type and Snellen are used.

Subsequently, a refraction test helps determine whether a patient requires spectacles. A spilt lamp examination is also carried out.

Patients above 40 years have their Intra Ocular Pressure (IOP) tested. This segregates patients requiring spcectacles from those requiring teleconsultation.

Teleconsultation involves dilating the pupils to detect diseases such as glaucoma, diabetic retinopathy, cataracts, among others.

"The patient's details are then transferred to Shankara Nethralaya where the refractionist and consultant sitting at Shankara Nethralaya arrive at a diagnosis," adds Murali

A Step Further

A patient being examined at one of the camps

SNTOP conducts other programmes like training teachers for screening the vision of children, teaches and trains local ophthalmologists, general physicians, optometrists, opticians and nurses and conducts awareness programmes in rural areas for the general public. "As far as our spectacle dispensing unit is concerned, spectacles are provided on the spot to patients at prices ranging from Rs 75-Rs 200," adds Murali. Patients with complex problems requiring further diagnosis and treatment and surgery are brought to the base hospital. Altogether, around 1,200 camps have been conducted, 1,20,000 patients examined and around 4,800 spectacles dispensed.

With the project initiated in Southern parts of Tamil Nadu, SNTOP now plans to form tie-ups for 3D telemedicine facilities.