Projectreport 2010 - Vision for the World

Eastern Regional Eye Care Programme
Sagarmatha Choudhary Eye Hospital, Lahan
Biratnagar Eye Hospital, Biratnagar
ANNUAL REPORT 2010
The Eastern Regional Eye Care Programme (EREC-P) is a high volume treatment
programme, which provides high quality comprehensive eye services at a cost affordable to a
huge population in eastern Nepal and northern India.
EREC-P comprises of:
Sagarmatha Choudhary Eye Hospital (SCEH) in Lahan,
Biratnagar Eye Hospital (BEH) in Biratnagar
7 Satellite Clinics/Primary Eye Care Centres in the Terai as well as in the hills.
HIGHLIGHTS:
84,921 Surgeries
2,358 Paediatric Surgeries incl. 1,200 on cataract
7 Surgical Camps in hill districts
to serve the poor in remote areas
Construction of new BEH complex progressing well

Annual Report 2010
OUTPATIENTS:
SCEH, Lahan : 128,511
Biratnagar Eye Hospital : 154,401
7 Satellite Clinics/PECCs : 61,488
143 Cat. Screening Camps’ Patients : 27,235
7 Surg. Camps’ Outpatients : 3,539
2 Diabetic Camps’ Patients : 139
TOTAL : 375,313
SURGERY:
SCEH, Lahan : 46,502
Biratnagar Eye Hospital : 36,064
Satellite Hosp. Malangwa: 1,788
7 Cat.Surg.Camps : 567
TOTAL : 84,921
Cataract : 68,899
Sutureless ECCE/IOL (SICS) : 52,547
Sutured ECCE/IOL : 1,388
On children : 1,200
Phaco ECCE/IOL : 13,593
Other lens removal procedures : 171
Glaucoma : 2,844
Trabeculectomy :1,098
Combined Cat&Trabeculectomy : 582
Trans scleral cyclo photocoagulation: 331
Nd. YAG iridotomy : 715
Surgical PI : 118
Corneal Surgical Procedures : 848
Keratoplasty : 14
Amniotic Membrane Graft (AMG) : 92
Corneo Scleral Repair : 325
Other Corneal Procedures : 417
Vitreo-Retinal Surgery : 999
Pars plana Vitrectomy : 965
Scleral Buckling : 34
Laser procedures : 3,356
Retinal Laser :1,413
Nd. YAG capsulotomy :1,943
Dacryocystorhinostomy : 1,621
Dacyrocystectomy : 1,021
Pterygium : 2,720
Others : 2,613
TOTAL : 84,921
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Annual Report 2010
SPECIAL SERVICES:
Paediatric Department
Examination: 27,607 children
Surgery: 2,358 (1,200 on cataract)
3,888 corneal ulcer patients
Cornea Department
Several awareness programmes for Eye Donation were organised in co-operation with
local organisations to increase understanding and acceptance of corneal transplantation in
the society. Due to these efforts 14 corneas were harvested and 487 people filled up eye
donation willingness forms.
Vitreo-Retinal (VR) Department
Fundus photography at SCEH
OCT at BEH
The VR Departments of SCEH and BEH are very well equipped with the latest technology.
The BEH and SCEH VR Departments run special awareness programmes on Diabetes, its
related blinding potential and possible early prevention with laser treatment and conducted
two Diabetic Camps.
German VR Specialist and CBM Co-Worker Dr. Iris Winter completed her 4-years contract
end of September. Dr. Pratap Karki took over the VR Department after her departure.
Glaucoma Department
Special glaucoma investigation was continued and 3,186 computerised visual field
examinations were done.
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Annual Report 2010
Low Vision Department
1,166 patients with low vision were assessed, including 338 children.
Special low vision devices were offered to those who required them for improving their
vision.
Subsidy to poor patients
90% of all patients pay NPR 1,000 (USD 14) for major surgery.
8,951 poor patients presenting at SCEH and BEH or in Screening Camps received free or
subsidized treatment or even food and transportation support, amounting to a total of
NPR 3,031,356 (USD 42,102).
OUTREACH ACTIVITIES:
Satellite Clinics (7)
Besides the Satellite Clinics in Malangwa, Rajbiraj, Siraha, Diktel, Gaighat and Bhojpur,
since 17 th September 2010 work has been taken up also in Terhathum.
Cataract Screening Camps
These camp activities are aiming at reaching Nepali patients who are either too poor to pay
for their surgery or live in remote hill areas and cannot come to SCEH and BEH for
treatment.
143 Cataract Screening Camps were performed in collaboration with local organisations in
the 6 Terai districts Siraha, Saptari, Sarlahi, Udayapur of Sagarmatha Zone and Morang &
Sunsari districts of Koshi Zone.
Out of 27,235 patients examined 4,992 were transported to SCEH Lahan, Biratnagar or
Malangwa and underwent cataract surgery free of cost or subsidised.
Cataract Surgical Camps
A blind patient was brought on a stretcher to the eye camp in Diktel, Khotang District.
After successful cataract operation on both eyes he happily walked home.
In 7 Cataract Surgical Camps in the hill districts Diktel, Bhojpur, Terhathum, Dhankuta,
Khandbari and Shiduwa 3,539 patients were examined and 567 eye surgeries performed, out
of which 484 were on cataract.
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Annual Report 2010
School Screening & Paediatric Camps
5,011 children were screened in 26 schools
and 44 found with refractive error referred to
SCEH or BEH.
536 children were examined in a special
Paediatric Camp.
HUMAN RESOURCE DEVELOPMENT and TRAINING :
Besides continuous medical education for the hospitals’ ophthalmologists the following
special teaching and training programmes were performed:
Anterior Segment Fellowship:
9 Ophthalmologists are undergoing two-year Anterior Segment Fellowship at SCEH and
BEH, which also includes training in sutureless cataract surgery (Fishhook Technique) and
phacoemulsification.
Vitreo-Retinal Fellowship:
Two ophthalmologists completed their Vitreo-Retinal Fellowship at BEH.
Co-operation with BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS),
Kathmandu and BP Koirala Institute of Health Sciences (BPKIHS), Dharan:
Post-graduate MD Residents in Ophthalmology:
3 Resident from BPKIHS, Dharan attended a one-month comprehensive clinical and
surgical training at SCEH and BEH.
3 Residents from BPKLCOS, Kathmandu attended a two-month comprehensive
clinical and surgical training at SCEH and BEH.
EREC-P is sponsoring three candidates for the three-year post-graduate MD
Residency in Ophthalmology at BPKLCOS, Kathmandu.
Optometrists:
7 Optometrists students from BPKLCOS, KTM underwent one-month training at SCEH or
BEH.
Co-operation with Nobel Medical College Teaching Hospital & Research Centre
(NMCTH), Biratnagar
According to a MoU for a one-year pilot period, starting from 15 th June 2010, BEH is
- providing classes in ophthalmology to medical students at NMCTH
- as well as Clinical Posting at BEH:
6 th semester students for two weeks
7 th semester students for one month
From 1 st August to 10 th December 115 MBBS students were posted at BEH.
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Annual Report 2010
MISCELLANEOUS:
Staff at all EREC-P Centres:
The 296 member staff include 19 ophthalmologists (1 VR surgeon, 7 long-term
ophthalmologists, 11 Fellows), 1 anaesthetist, 18 administrative staff, 19 ophthalmic
assistants (OA) and 15 OA trainees, 9 health assistants, 1 optometrist, 58 eye health workers
and 76 eye health worker trainees.
“Cataract Package Tours”:
13,399 cataract patients, collected by 34 agents in North-India, were brought to Lahan and
Biratnagar for surgery.
Co-operation between SCEH and IMPACT Nepal in Lahan:
SCEH had been providing support and part of its premises free of cost for a Primary Ear
Care Centre (PECC) and surgical ear camps to IMPACT for a pilot period of more than two
years.
Now IMPACT is renting the premises, and two ENT surgeons are providing full-time ear
surgery and in-patient services for the benefit of patients with hearing impairment and ear
diseases.
Visitors & Visiting Faculty & Guest Lecturers:
28 visitors came mainly to observe the eye work at either one or both EREC-P hospitals.
Prof. Christian Mardin, University Erlangen-Nuremberg, Germany provided clinical
training to ophthalmologists, residents and ophthalmic assistants and spoke on various
glaucoma topics in March.
Dr. Bernd Schroeder, senior ophthalmologist, Asklepios Klinik Nord in Hamburg,
Germany provided clinical training to ophthalmologists, residents and ophthalmic
assistants as well as teaching squint surgery in March.
Prof. Stefan Dithmar, VR Specialist, University Eye Hospital, Heidelberg, Germany,
provided Retina lectures as well as clinical and surgical refresher training in March/April.
Prof. Arin Chatterjee from India provided Continuous Medical Education for
ophthalmologists and ophthalmic assistants in June/July.
Various Trainings / Workshops and Conferences at EREC-P:
Various orientations and short and long-term ophthalmic trainings continued also in 2010 at
EREC-P:
in form of staff exchange programmes & training between SCEH and BEH
44 Eye Health Worker Trainees are undergoing a 3-year Eye Health Training
6 Health Assistants completed their 6-months Eye Health Training
6-months Eye Health Training: 58 Auxiliary Health Workers and Auxiliary Nurse
Midwives completed their training, 33 are under training
Short-term Primary Eye Care Training to Staff Nurse & Health Assistant Students,
Health Posts-in-Charge, Drug Retailers, Traditional Healers and Female Community
Health Volunteers
5 th Eastern Regional Ophthalmic Conference, BEH, Biratnagar, 27.3.2010:
- Prof. Christian Mardin, guest lecture: Current application of OCT in fundus imaging
- Ophthalmologists, Ophthalmic Assistants and optometrists of SCEH and BEH
participated and contributed with presentations.
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Annual Report 2010
Mr. Anil Singh from CMCH, Ludhiana provided a 3-week Ocular Prosthesis training
in Aug./Sep. to one staff each from BEH and SCEH
Patient before and after being supplied with an ocular prosthesis made at SCEH
3-days Conflict Management Training, SCEH, Lahan, 3.-5.9.10: 18 EREC-P staff
Eastern Regional Low Vision Workshop, SCEH, Lahan, 16./17.12.10: 12 participants
Various Trainings / Meetings / Workshops and Conferences in Nepal:
CBM SARON Regional Strategy Consultation Meeting, KTM, Jan.2010: Dr. A.
Hennig, Dr. Sanjay Kr Singh, B. Mahato.
Eye Bank Workshop, Tilganga Eye Centre KTM, 15.-18.4.10, Dr. Sanjay K. Singh
Pediatric Ophthalmology Strabismus and Neuro Ophthalmology Workshop,
Lumbini Eye Institute, Lumbini, Bhairahawa, 22./23.5., Dr. Lalit Surin
One-week Specific Ophthalmic Diseases Training at Tilganga Eye Centre, KTM, 25.-
30.7.10: Dulli Raj Timilsena
Cornea Conference, Tilganga Eye Centre KTM, 1.10.10: Dr. Sanjay Singh
Paediatric Ophthalmology Workshop organized by ORBIS and NNJS, KTM, 31.10-
3.11.10: participants from SCEH and BEH
International Cornea Conference, TU University Teaching Hospital, KTM,
9./10.12.10: Dr. Sanjay Singh: Ocular Surface Reconstruction in Nepal: Our experience
with fresh amniotic membrane transplantation at Biratnagar Eye Hospital.
Courses / Workshops / Conferences & Presentations outside Nepal:
- All India Ophthalmic Society Conference, Kolkata/India, 20.-23.1.10:
Drs Nishith Prakash, Lalit Surin & Mr. Sudhir Thakur
- Dr. Sanjay Singh: CBM Workshop on Quality Eye Care, 7.5.10, Delhi
- Dr. Pratap Karki: CBM Workshop on developing medical retina services in secondary
level eye hospitals, 6.5.10, Delhi
- Dr. A. Hennig: Lions Bremen/Germany, 26.7.10: Eye Work in Nepal
- Dr. A. Hennig: World Ophthalmic Congress (WOC)/AAD Congress: 3.-6.6.2010,
Berlin/Germany: SICS Fishhook Technique and tips for avoiding complications in “Modern
Manual Cataract Surgery” session
- 2-month certificate course in Fundus Fluorescein Angiography and Ultrasonography at
Aravind Eye Hospital, Madurai/India: 1.7.-28.8.10: Mr. Ram Pragash Mahato
- Dr. Sanjay. K. Singh & Dr. Lila Raj Puri: 25 th APAO Congress, Beijing/China, 16.-20.9.10
- Dr. A. Hennig: Presentation for Ophthalmologists in Karlsruhe/Germany on 15.10.10:
Ophthalmic work in Nepal
Dr. A. Hennig: 3 rd DOC (International Congress of German Ophthalmic Surgeons), 21.-
24.10.10, Hamburg/Germany: 1. Keynote Lecture: The Change in cataract surgical
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Annual Report 2010
techniques at the example of Nepal; 2. Paediatric Cataract; 3. Long-term Assignments in
Developing Countries; 4. Wetlab Instruction Courses on Suture less non-Phaco Cataract
Surgery (Fishhook Technique)
- Satya Srayan Singh as LV Trainer for Tanzania: 2-weeks LV Training (1.-14.11.10) for
eye care staff from Tanzania and other African countries - in cooperation with KCCO
(Kilimanjaro Centre for Community Ophthalmology) in Moshi/Tanzania.
- 12-days Programme Management & Evaluation Training at LVP, Hyderabad/ India, 6.-
18.12.10: Bindeshwar Mahato & Sudhir Thakur
Awards:
- Dr. Rinki Kumari Singh, senior SCEH ophthalmologist, has been recognized as Visiting
Faculty (Assistant Professor) of BPKIHS, Dharan on 1.6.10.
- NNJS Central Office Kathmandu awarded “Netrajyoti Samman Puraskar” to Mr.
Rabindra Lal Chaudhary, Chairman SCEH, for Social Work in Eye Care Services on 3.7.10.
- Dr. A. Hennig & Ms Kristina Hennig: “Bundesverdienstkreuz” or Federal Cross of Merit
or Order of Merit of the Federal Republic of Germany, awarded on 29.3.10 by the
German Ambassador Ms Verena Graefin von Roedern.
- Dr. A. Hennig & Ms Kristina Hennig: Quadriga Award, awarded on German Unity Day
(3.10.10) in Berlin, Germany.
Publications:
- Singh SK, Bharali P, Winter I
Wound infection after cataract surgery: a report of two cases
Nep J Oph 2010;2(1): 59-63
- Hennig A
Sutureless Cataract Surgery with Nucleus Extraction – “Fishhook Technique”
Book Chapter (36) in Ashok Garg and Jorge L. Alio: Surgical Techniques in
Ophthalmology, (Cataract Surgery)
Jaypee Brothers Medical Publishers, New Delhi 2010: 195-198
- Hennig A
Cataract surgery in Nepal: then and now
Guest Editorial, Nep J Oph 2010; 2(4):83-86
Nep J Oph 2010; 2(3):3-9
- Sarkar S, Mardin C, Hennig A
Profile of the glaucomas and intervention in a large eye care centre in South-East
Nepal
Nep J Oph 2010; 2(3):3-9
- Hennig A, Singh S, Winter I, Yorston D
Can phaco be a cost-effective solution to cataract blindness? Costs and outcomes in
Nepal
Correspondence in EYE, Epub advance online publication 2009 November: 241
and: Eye (Lond). 2010 Jun; 24(6):1104
- M.E. Wilson, A. Hennig, R.H. Trivedi, B. Thomas, S.K. Singh
Clinical Characteristics and Early Post-Operative Outcomes of Pediatric Cataract
Surgery with IOL Implantation from Lahan, Nepal,
J Pediatr Ophthalmol Strabismus. 2010 Sep 22:1-6. doi: 10.3928/01913913-20100920-03.
[Epub ahead of print]
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Annual Report 2010
Construction of a new Biratnagar Eye Hospital Complex:
The presently rented buildings of BEH are hardly sufficient to accommodate the growing
number of patients and are used at their capacity limits.
Therefore the construction of a new 300-bed eye hospital with facilities for outpatients and
surgery, special departments and training as well as hostel and staff quarters was started in
October 2009 and is expected to be completed in 2011.
CBM Co-worker Mr. Josef Schneider from Austria is the Project Manager for the
construction.
Financial Support:
In addition to CBM as major donor the following organizations are also
sponsoring the Eastern Regional Eye Care Programme:
European Commission (EC)
The EC is supporting the Eastern Regional Eye Care Programme for 4 years (2008-2011) for
“Improving the Quality of Life of Vulnerable Target Groups in the Eastern Region of Nepal
by Improving Eye Care and Sight Restoration”.
Standard Chartered Bank (SCB)
SCB is supporting the Eastern Regional Eye Care Programme
for 4 years (July 2009-June 2013) through its Seeing is Believing (SiB) Programme in order
to strengthen the eye care service delivery in eastern Nepal and significantly reduce the
prevalence of blindness in Eastern Nepal, thus improving the quality of life and economic
situation of reversibly blind persons and those at risk of blindness.
Acknowledgements:
The Programme Director gratefully acknowledges the support rendered by CBM and their
donors and the partner organizations Social Welfare Council and Nepal Netra Jyoti Sangh as
well as the European Commission, Standard Chartered Bank, German Donor initiatives and
the local community.
He would also like to thank his colleagues and all staff members who as an enthusiastic team
made the eye services of the Eastern Regional Eye Care Programme such a success.
Dr. A. Hennig
Programme Director
Eastern Regional Eye Care Programme
Mail address: G.P.O.Box 15108, Kathmandu, Nepal
Email : info@erec-p.org; albrecht.hennig@erec-p.org
Website : www.erec-p.org
Photos: © EREC-P and Roger Lo Guarro
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