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An Indian mission: specialist optometrist at Moorfields Eye Hospital, Rajula Karania, shares her experiences of training an ophthalmic team in Bihar, India, to be able to offer refraction to children in need of eye care.

Having completed my post graduate training two years ago, I found myself thinking: 'What now?' I wanted to do something different.

Then, one day, an email appeared in my mailbox that caught my eye. It read: 'Optometrist urgently wanted in India.' Curiosity got the better of me and I hit reply.

An ophthalmologist called Lucy Mathen was seeking an optometrist to travel to Bihar in India to train a local ophthalmic team. I had been looking for an opportunity to do voluntary work abroad, particularly teaching. That said, the remote north eastern state of Bihar was unknown to me, but is where my origin is from.

Moorfields to Bihar

Ms Mathen founded Second Sight, which aims to cure treatable blindness in Bihar by providing free cataract surgery to people in the state who have no access to healthcare.

Second Sight has six partner hospitals across Bihar, each working to irradicate reversible blindness in a specific region of the state.

Prior to my trip, a new paediatric unit had been established at the Laxman Eye Hospital and an optometrist was needed to train a few local ophthalmic assistants who had already undergone a local government-run optometry course, but had very little practical skills in vision testing and refracting children. The team was already screening children for congenital cataracts, but was unable to provide, pre- and post-operative care with refraction. This is what I would be there to do.

When in India

With a leap of faith, I agreed to take on the challenge. The two ophthalmologists and the director of the hospital welcomed me on my arrival and the hospitality was overwhelming.

Retinoscopy is quite a difficult technique to teach as it is a practical skill where the person demonstrating cannot see what the trainee sees, and vice versa. This was further complicated by having to teach in Hindi. Needless to say, translating some of the ophthalmic terminology in to Hindi was a huge challenge.

Training days were long, combining formal theoretical teaching and practical work.

The patients had travelled for hours to get to the hospital, with some children dressed in their best clothes for the visit. What struck me was how well behaved they were, sometimes not having anything to eat or drink for hours while waiting, and then sitting quietly for a few more hours while the trainees practised on them.

In total, we saw around 80 children, aged one to 17 years, in a week. A large proportion of the people we saw had uncorrected refractive error and were in dire need of spectacles.

The other single-most important cause of childhood blindness in India is from Vitamin A deficiency, which causes xerophthalmia and night blindness. I had never seen this pathology before, yet it was a common finding in Bihar. Children presenting with corneal ulcers and Bitot spots was also common. A new interventional research project, FAME, was launched by Second Sight while I was there to address this problem and help prevent it.

Career development

This was an extremely rewarding experience, which allowed me to step out of my comfort zone and undertake a teaching role. It was an immense learning curve for the local team too, who all mastered the techniques and are now able to provide ophthalmic care to the underprivileged children attending the new paediatric clinic.

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Rajula Karania is a specialist optometrist at Moorfields Eye Hospital
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Title Annotation:PERSPECTIVES
Author:Karania, Rajula
Publication:Optometry Today
Geographic Code:9INDI
Date:Mar 1, 2017
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