Foresight Philippines Program Update 2015
On 25 April our team of volunteer eye specialists travelled to Adventist Hospital Santiago City, Philippines to perform sight saving cataract surgery on some of the estimated 400,000 people suffering from avoidable blindness in the Philippines.
Santiago City is situated in the Cagayan Valley in Northern Luzon, a rural area situated over ten hours drive north of Manila. With a large population, high levels of poverty and no comprehensive eye-care services, this region has one of the highest rates of blindness in the Philippines.
“Cataract is by far the major cause of preventable blindness worldwide,” said A/Professor Geoffrey Painter, ophthalmologist and Foresight Board member.
“While the data around cataract rates is incomplete, it is estimated that, in the Cagayan Valley area, the rate of vision impairment at 4.94 per cent is double the country’s average with cataract blindness being the major problem. There also seems to be a disproportionate amount of childhood cataract due to the lack of access to hospital facilities for many of the most vulnerable” he said.
The Philippines has a population of over 100 million on a landmass of just 300,000 km2 spread over 7,000 islands. That is five times Australia’s population occupying land that is 25 times smaller. It is estimated that 25 per cent of the Filipino population lives below the poverty line which is the equivalent of just AU$1.30a day. The pressure on the Philippines healthcare system is immense because of this.
“From what we can establish, there are potentially 45,000 cataract cases in the area. There is a gap in the healthcare system in this district where we see the poorest in the community fall through. There are only a small number of hard working local ophthalmologists in the district and no established public eye care services.
Universal health insurance for those over 60’s has only recently been introduced and will take a while to filter through those in need. If they are unable to pay for eye care services then many wait blind for years,” said A/Prof. Painter.
The 2015 visit resulted in 127 cataract operations in just seven days of operating by A/Prof. Painter and Dr. Sara Booth-Mason, assisted by theatre nurses RN Kerrie Legg, and RN Danielle Bishara. Registrar Dr. Dominic McCall screened hundreds of patients in the eye clinic while providing valuable training to the local nursing team.
“We’ve seen patients present here with advanced conditions you just don’t see in Australia,” said Dr Booth- Mason.
“During this visit we’ve seen bilateral blindness with only perception of light in both adults and children. We’ve seen advanced cataracts that are dense and swollen and have caused severe secondary glaucoma. Some patients have been blind for over a decade and their cataracts neglected for so long that their blindness is not curable because of the damage to the optic nerve.
“It has been a bit of a roller coaster emotionally with the joy of giving sight back to many but being totally unable to help others and finding other severe disease that has limited some outcomes. Especially difficult is seeing the children aged, seven, ten, and even 14 with congenital cataract that should have been treated earlier and blindness prevented,” said Dr. Booth-Mason.
One of the highlights of the visit for the team was to see the progress the Adventist Hospital Santiago City staff had made in the last four-and-a-half years.
“They’ve developed skills in screening, examination, sterilisation and ophthalmic surgical workflow that has enabled a very successful surgical visit this year,” said Kerrie Legg who was part of the initial ophthalmic investigative visit.
“While it is always nice to see the development of infrastructure, to see the progress of the local people involved is even better and provides great optimism for the future of the project.”
While it is vital to tackle the prevalence of cataract in the Cagayan Valley region with increased surgical capacity, it is also essential to build a sustainable service. Those with the greatest need should be able to access eye services before problems that lead to irreversible blindness develop.
The first step in establishing such a service is to implement a screening program for the regional and remote areas surrounding Santiago City. The current program relies on advertising in town markets, the local Adventist Hospital medical visits in the area, referrals from local ophthalmologists and word of mouth. There is currently no systematic, sustained eye screening service available to the population in regional and remote areas.
There are many barriers preventing patients from travelling to cities to gain access to eye health care. The cost of travel, having to rely on a family member to accompany them, the cost of the service, the availability of the service and simply knowing what services are available and where to find them keep people who are blind from accessing the help they need.
This is why Foresight aim to develop a vision screening program for these regional and remote areas that will include employing, training and equipping an ophthalmic nurse and enabling that nurse to visit areas with limited access to ophthalmic services.
“We hope this screening program will empower the local hospital to find those most in need in these areas and help bring them for treatment before it is too late,” said A/Prof. Painter.
“Once the screening program is established, increased surgical capacity, consumables and surgical training support will be needed, initially from our group with the assistance of local surgeons and ultimately from local surgeons themselves as their numbers increase.
“To ensure the long term reduction of avoidable blindness for the people of the Cagayan Valley the project needs to be sustainable using local resources and manpower. We are currently giving support but self-sustainability is our ultimate goal,” A/Prof. Painter said.
Everyone has the Right To Sight
Blindness has a profound human and socioeconomic consequence in all societies. Volunteer services provided by organisations like Foresight can make an enormous difference.
“We volunteer our time and skills to places like the Cagayan Valley because ultimately we believe that everyone has the right to sight. To be able to restore sight to people who would otherwise have been denied the chance to see again, is the reason we have developed this project,” said A/Prof. Painter.
“Without sight, in countries that are unable to provide support services to the visually impaired, people are unable to get an education… they are limited by what they can do with their life and that leaves them trapped in a cycle of poverty. We are hoping to change that for as many people as we can.”