Pediatric Cataract Surgery in Nigeria A Camp Approach. Dr. Tulika Kar Senior Consultant Ophthalmologist Tulsi Chanrai Foundation, Nigeria

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1 Pediatric Cataract Surgery in Nigeria A Camp Approach Dr. Tulika Kar Senior Consultant Ophthalmologist Tulsi Chanrai Foundation, Nigeria

2 Mission For Vision, India Indian consortium that addresses the issue of Blindness. Experience with Eye care over last 19 years MFV: Partners in India with 10 leading eye hospitals since 1992 Total of 163,800 surgeries in 2010 Tertiary Eye care Specialized Pediatric eye care in 5 of these centers Facilitated 4332 Pediatric Eye surgeries since 2007 Anand Shimoga Rishikesh Silvassa Nasik Guntur Coimbatore Bangalore Chennai Krishna Kovil Facilitated 1 million surgeries since 1992

3 Tulsi Chanrai Foundation - Nigeria TCF is among the largest grass root implementation INGO operating in Nigeria with a reach of around 1 million people 3 core focus areas are Primary Health Care, provision of safe drinking water and Eye Care Eye Centre in 5 states across the country and 5 different geo political zones Strong partnership with state government Focuses on Primary and Secondary eye care services Kebbi Imo Katsena CRS Adamawa

4 Tulsi Chanrai Foundation - Nigeria Approximately 73,000 sight restoring cataract surgeries conducted TCF is currently performing almost cataract surgeries annually - a CSR of 100 per million population, a third of the cataract surgeries done in Nigeria 3 Pediatric eye camps: January patients, 73 eyes June patients, 104 surgeries August patients, 145 surgeries ( in partnership with ORBIS ) Total of 213 patients and 322 surgeries under GA and 49 YAG Capsulotomy at 6 month review.

5 Camps Background Primary and Secondary eye care in 4 centers in Nigeria. Non availability of safe General Anesthesia (GA) for pediatric cases. Access to a referral centre for Pediatric cataract surgery under GA is difficult for many from rural areas. Solution: Pediatric cataract surgeries in a centralized set up at Abuja Staff, Systems and Protocols Pediatric eye surgeons TCF & MFV Anesthetists- 2 from India, 1 from Nigeria Paramedical Staff- from Nigeria Equipment imported from India or shifted from centers in Nigeria Standard systems and accepted clinical and surgical procedures appropriate for safe and successful surgery Quality maintained at all levels

6 Credentials of Ophthalmologists India: Medical Director of Mission For Vision is the ex CEO of Sankara Nethralaya, Chennai, India, and is a Pediatric Ophthalmologist Strong technical back stopping from MFV, India Nigeria: Senior Consultant Ophthalmologist trained in: Aravind Eye Hospital, Madurai, India- Fellowship in Anterior segment, Cataract and Phaco Sankara Nethralaya, Chennai, India: Pediatric Ophthalmology

7 Core Achievements- since 2009 Secondary and tertiary eye care to walk in pediatric patients at 4 existing centers Conducted pediatric screening camps in Ogun, Zaria and Adamawa state to treat refractive errors, cataracts and other ocular pathologies Operated 213 children eyes from wide geographic distribution within Nigeria Trained 2 Ophthalmologists and 1 Nurse anesthetist in Pediatric cataract surgery and Anesthesia in partnership with ORBIS in August 2010 Advocacy with Federal and State governments regarding child eye care.

8 Lost Opportunity: Medically unfit patients have to wait for the next camp Drop Out Rate: 38% at 6 months review from Aug 2010 camp Dispensing/ Making of spectacles Lack of community linkage till the tertiary level leads to delayed reporting of pediatric cataract. Poor visual rehabilitation despite appropriate intervention due to delayed reporting. (6/18 or better in 33.5% cases) Challenges

9 Camps - Capital Investment Equipment Quantity USD Operating Microscope with sidescope Phacoemulsification System (Oertli) Anterior Vitrectomy Machine NIDEK YAG Laser Autoclaves A Scan Biomedics Hand held slit lamp Ophthalmoscopes ( direct/ indirect) Instrument sets Hand Held slit lamp Total

10 Camps - Running costs Camp Children operated Eyes Operated USD Average/ Surgery January USD June USD August USD Total Total Investment: USD

11 TCF s Future Plans for Pediatric Eye care Services in Nigeria Objective: to provide sustainable pediatric eye care at primary, secondary & tertiary levels and build capacity within the country Create an Effective 3 tier referral system and community linkages in our current area of work, e.g. have a vision centre in each of 21 Local Government Areas of Adamawa state in the next 3 years Continue with 2 pediatric surgical eye camps / year till the Abuja hospital comes up Comprehensive Eye Care centre in Abuja with all Ophthalmic subspecialties & a dedicated Pediatric eye care department 5.5 acre land donated by the Federal Government (FCT) Construction to begin this year Commissioning by 2012 Training to ophthalmologists, anesthetists and paramedical staff in pediatric eye care during our surgical camps and at the Abuja Hospital

12 HR Issues Requirements in the states to strengthen Primary Eye Care: A Pediatric Optometrist (from India) to oversee: Optometrists & counselors from states Optical services: for making and dispensing spectacles Low Vision Aids Tertiary Eye Care Center, Abuja Trained Professionals will be hired from India and Nigeria Experience and expertise from MFV Opportunities for training and fellowship programs

13 Key Outcomes - in the next 5 years Educate the population within our project areas about child eye care and availability of an affordable eye care centre Treat all pediatric eye conditions at the tertiary eye care center at Abuja Capacity building through Fellowship programs in Pediatric Ophthalmology & pediatric eye surgery anesthesia.

14 Proposed Abuja Hospital