The TIO’s outreach programs play an important role in serving the poorest segments of the population in the most remote and underserved areas. This is where blindness hits communities the hardest. Since most Eye Hospitals in Nepal are located in the plain lands, people don’t get hospital services. The best way to reach such population is by outreach programs. These areas are those locations where establishing an Eye hospital is not feasible.

The TIO’s outreach program is the leading outreach program in Nepal. Further, Tilganga assists and supports other institutions inside Nepal and outside country to conduct their own outreach programs through the supply of intraocular lenses and provides professional expertise.

Outreach Microsurgery Eye Clinic (OMEC)

For generations blind people who are poor and live in remote un-served areas had nowhere to go. Their life expectancy was cut short. Most of these people were blinded by cataract (72% of total blindness in Nepal is caused by cataract). The TIO developed a system where we can safely give vision back to these people - immediately after surgery. Thousands of patients have benefited from this initiative, which we have termed as OMEC (Outreach Microsurgical Eye Clinics).

Most OMECs are structured to optimally accommodate around 1,200 outpatient and 250 surgical cases. Patients are screened, treated, and asked to remain at the OMECs site for two days, after which they are examined and discharged with instructions in postoperative care. A follow-up is scheduled one month after OMECs, and those patients who return are examined, and treated. In every case, the greatest effort is made to ensure that the quality of care received is the same as that available in the TIO base hospital. In fact, the system of patient management utilized at the TIO has been patterned on the organization of OMECs. All the medical consumables used in OMECs are checked and assured for quality. The success of our OMECs also depends on the cooperation of the communities that are served. The help from the local organizations, including schools, general hospitals, Red cross, Scout, youth clubs and social groups supplying volunteers make the camps more functional. These volunteers assist in organizing, locating and managing patients as well as other provisions such as food, shelter and bedding for patients before and after their operations. To further increase community involvement, general health workers are trained at the TIO in basic eye health so that they can be sent throughout the country and assist in patient screening and case selection for future OMECs.

With the present level of development in Nepal and its neighboring countries, it is clear that there will be an ongoing need for OMECs for many years to come. For as long as this is true, the surgeons and staff at the Tilganga Eye Centre will work to ensure that the quality of treatment available in these clinics and the number of patients whom they reach, continue to improve. It is only through these clinics that the most deserving and underprivileged members of our community receive an essential service.

The TIO’s annual Outreach Programs consist of more than eighteen Outreach Microsurgery Eye Clinics (OMECs) and 60 one-day screening clinics. All these are conducted in remote parts of Nepal. In the course of time, our efforts have also extended to neighbouring countries. Viz. Tibet Autonomous Region-China, Main land (western part) China, Bangladesh, Bhutan, Cambodia, India and in DPR Korea. When needed, the surgeons and assistants from these countries are trained in the techniques used in TIO’s OMECs and together they perform as many as 2,000 cataract operations in a week. Since 1994, Tilganga's surgeons have conducted a total of 200 such OMECs, examining almost 282,315 outpatients and performing more than 52,300 cataract surgeries. Most of the OMECs have been held in remote parts of Nepal, but our efforts have also extended to other countries.

DATA SUMMARY OF THE OUTREACH MICROSURGICAL EYE CLINICS

Year:  1994-2009

Financial support for microsurgical OMECs is provided by a variety of donors, including individuals and service organizations, the Nepal Eye Program Australia, The Fred Hollows Foundation, AusAID, NAFA-Queensland, SOIR-IM Sweden, Vision Tibet-Switzerland, All for Charity Australia Inc, Buddhist Charity Foundation Hong kong-China, Henkel Smile-Germany, Anand Sangh Pullahary Monastery-Nepal, the Tibet Development Fund, and the Himalayan Cataract Project.

One-day Outreach Screening Eye Clinics

Most of the elderly people are not aware of slow visual acuity deterioration in later life. Screening clinics are one of the most effective methods to detect cataracts. In addition to old-age blindness, childhood blindness accounts for a relatively large percentage of blindness (about 3.5% of total blindness in Nepal). Until recently there were no national programs specifically targeted at this age group (viz. children). The TIO initiated to provide services for this sector. Every year, the TIO examines around 3000 children and brings them to the base hospital for treatment.

The TIO encourages screening programs in public schools. Teachers of these schools are also brought to the TIO to train in the art of visual acuity testing in children. These programs are held in close association with local communities.

A date and venue is fixed and widely advertised to ensure as many people of the respective area may attend the TIO screening clinic. Common eye problems are treated at these clinics themselves, but patients with low vision and blindness are referred to the TIO base hospital. At the same time, with the purpose to disease prevention, a group of the TEC’s Ophthalmic Assistants (OAs) are involved in a program of imparting eye health education to that community.

RURAL COMMUNITY EYE CENTRES

Tilganga has also initiated a project to build Community Eye Centers (CEC) in underserved districts of Nepal. At present, there are 10 CECs in operation at Phaplu (Solu), Manthali (Ramechhap), Hetauda (Makawanapur) and Bhaktapur – funded by the Himalayan Cataract Project (HCP), and at Dhading Besi (Dhading), Chautara (Sindhupalchowk), Bidur (Nuwakot), Rasuwa (Dhunche) – funded by the Fred Hollows Foundation (Australia) and Okhaldhunga an Rolpa funded by Fred Hollows Foundation (UK). The establishment of more Community eye Centres in underserved districts are planned.

These CECs are manned by two people - a local person, who has been trained at Tilganga to be an Ophthalmic Assistant (OA), and an Eye Worker. After a year, a second OA will be posted to them to enable a more aggressive program of screening around their Districts, which in some cases are quite large. These CECs act as referral Centre, and the staff treat eye infections and disease, remove foreign bodies, which are the main cause of corneal blindness if untreated, perform minor surgery on Pterygium, entropion correction, cysts, etc., and refract and sell spectacles. The numbers these CECs are handling varies naturally, but on an average, it is about 150 to 500 patients a month.

The OA also do screening within the community and at schools. Each year an OMEC is held in that CEC’s District. The OA holds public eye care meetings and training sessions in basic eye care, and eye disease for Community Health Workers and schoolteachers.