Kasto Charlanga Dekhiyo translates to I can see very clearly. These were the very words uttered by one of the patients, 70 year old Navraj Gurung at the Eye and ENT follow up camp held at Bansar Hile village in Lamjung District in March 2019 after a week of the surgery camp. He praised the doctor, Deepak Khadga and mentioned that he was very happy he could see with both eyes now and it had all been done now free of cost. He had cataract surgery in both eyes.
Eye and ENT professionals from B.P. Eye Foundation’s Hospital for Children’s Eye and ENT Services(CHEERS) held Eye and ENT surgery and follow up camps in February and March 2019 in Lamjung and Tanahun Districts. This included providing health services, special assistive devices like optical glasses, hearing aids and low vision devices, awareness raising among the people, and identifying children with sensory disabilities for their habilitation and placement into mainstream education in three municipalities of the districts.
A collaborative effort of BPEF-CHEERS and Nepal Red Cross Society and Danish Red Cross, the overall goal of the programme was to empowering and include people with disabilities who have not been provided with services in earthquake-affected communities in Nepal by providing services at their doorstep which would help in alleviating disabilities.
Both Tanahun and Lamjung Districts, in the mid-hills of Nepal fall in Gandaki Pradesh in Province 3 and have a mixed population with a predominant Gurung community having their own rich culture and traditions. Most of the younger population, especially men have migrated to other cities in Nepal, or other countries for better work opportunities leaving behind a large number of elderly people, women and children.
Like in most outreach camps, especially remote rural ones, there were more females than males in these camps too. This is because women have to plan their doctors’ visit around their work both at home and in the fields, children, husband and in-laws. Only once they get time from all this, they attend to their own health.
A total of 172 surgeries were undertaken (146 eye and 36 ENT surgeries) at the four camp sites of Thuldhunga and Rishing (in Bhanu and Municipality of Tanahun District) and Sera and Hile (in Dorde Rural Municipality at Lamjung District) with 150 patients(120 Eye in and 31 ENT patients came in for follow up. Some of the common eye problems found among the people were cataract, presbyopia, refractive error and dry eyes whereas the common ENT ones were pharyngitis, Sensory Neuro Hearing Loss(SNHL) Eustachian Tube Dysfunction(ETD) and Chronic Otitis Media(COM). For sustained services BPEF-CHEERS also organizes a follow up visit to the camp site one month after the camp, to find the outcomes of operated patients and check the status/use of equipment and supplies (Otoscope, Jobson Horne probe, Tuning Fork, Aural metallic syringe and vision chart) handed to the trained local health professional of the community.
There were a few interesting cases worth mentioning at Sera and Hile camps. Seventy on year old Karna Singh Gurung from Sera had not been able to see properly for two years before he had his eye operated at Sera Camp. Although his vision is still a little blurred, now he is glad he can see much better than before. His sixteen year old granddaughter Asmi, also present at the Camp for a follow up of her surgery for a damaged ear drum is pleased too. She was happy that her grandfather could see much better.
Lal Kumari Gurung an eighty year old widow who lives alone was overjoyed that she could now see after getting both her eyes operated as she could not do her daily living activities independently. She came with her two grandsons- sixteen year old Chokendra Gurung and 27 year old one who lives in Chitwan. Her grandsons were equally happy that she could go about doing her daily chores independently. Many elderly patients like Karna Singh and Lal Kumari live alone and fend for themselves as their children have migrated to other cities of Nepal or other countries like India, Korea, Saudi Arabia, UAE, Cyprus and Jordan in search of better work opportunities which are not available in the village. Many others are often accompanied by their grandchildren, neighbour or a relative.
One of the more health conscious patients, Purna Bahadur Gurung who had an operation for an ear drum perforation had his stitches removed at the health center in Sera the morning as the BPEF-CHEERS team got delayed. A few patients like him were mindful and followed the instructions of the professionals.
Members from our partner organization were present throughout the camps. Suman Rai Junior Engineer said, “this programme is part of Red Cross’s earthquake response operation where disability inclusion is a cross cutting issue. Since the camps are happening at people’s doorsteps it is very convenient for the community. People are very happy that they can see and hear especially the ones who have had cataract surgery.” He also mentioned that the strategy used for information dissemination was through word of mouth- which included informing the community leaders of the different Wards as well, advertising on the radio, putting up posters and distributing pamphlets.
Another elderly man Tulku Lama-72 year old from Bansar Hile had both his eyes operated for cataract. He can see more clearly with both eyes and was extremely happy that he could work and earn a living now. Since his grandson has broken his dark glasses he hoped that the follow up team would give him another pair. Many patients kept requesting for dark glasses, prescription glasses and free medicines sometimes not realizing that certain medicines or glasses were not for them. It was a little difficult to communicate with patients as they did not understand or speak Nepali very well. Translators had to be used.
The camps were not without its challenges. There was a general lack of health awareness among people despite being informed on the dos and don’ts of pre and post operation. A few had not followed instructions given by the doctors/professionals either because they did not understand or did not take it too seriously. One or two had not avoided alcohol and/or smoking. Written instructions were given for family members since most of them were not literate or could not understand or were likely to forget. Patients had walked long distances from 1 to 4 hours from neighbouring villages to attend the camps. Despite having to travel long distances people showed up. A few came inquiring about outpatient services and wanted to be examined.
Amit Yadav, Associate Health Assistant at the Health Post in Bansar Hile- was appreciative of the fact that this health camp was being held in Bansar Hile. He mentioned, “more health camps are undertaken in Sera. In the past one year, a comprehensive camp of this nature has been the only health camp organized in Hile Bazar”.
Twenty seven year old housewife, Usha Khatri was worried that she could only hear slightly better after her ear surgery for her eardrum. However after the professional removed her ear pack she could hear properly and was relieved to know that her hearing would slowly be restored in 3 weeks and maybe completely in a little over a month.
Although by and large the camps were fruitful, more of this type of community based service in hard to reach areas of the country will be of great benefit to those marginalized groups and communities. Since the people are separated by distances and means to reach health care institutions, we should go to them more frequently.