Bisha. Health sciences and medicine Proofreading: Eye Care programm GRNT Proposal - Essay Example

?Introduction: Bisha is located in south west of Saudi Arabia, by the border of the central province in the South-Western region. This region is rocky desert land and it lays 300 meters above sea level. In addition, there are two main factors which indicate that Bisha is a typical area for prevalence of blindness and visual impairment a good area in which to study the causes of the impairments. Firstly, Bisha is a multi-tribal area where other Saudi regions are represented with various cultural habits. Secondly, there are limited ophthalmic and optometry sectors in this region comparing with its population (Al Faran, M.F., 1993). Therefore, the blindness and visual impairment vision are one of the most common health problems in South-Western region of Saudi Arabia. In 1984, according to the national eye survey, 1.5% of Saudi population was blind and 7.8% of them had a visual impairment as reported by World Health Organisation (Tabbara, K.D., 1987). In 1993 the survey conducted in Bisha estimated that the prevalence of blindness was 0.7% and the visual impairment prevalence was 10.9% from a population- based survey. The study indicated that a high range of the incidences were among the age 40 years and over, the prevalence of blindness was 89.5% and the prevalence of visual impairment in thirty subjects (aged 40 to 59 years) was 44.7% and for 100 of the subjects (60 years and over) was 66.2 %. However, the major causes for blindness and visual impairment are cataract and refractive errors throughout Bisha and its surrounding suburbs (Al Faran, M.F., 1993). Cataract: the term cataract is defined as any degree of opacity of the crystalline lens of the eye. It is a major cause of blindness among people 40 years and over in the world (Steinert, R.F., 2010). As of 1995, age related cataract accounts for 50% of whole world blindness, which is about 25 million people. The prevalence of cataract cases is estimated to grow to 30 million in 2020. In Bisha, the main visual problems caused by cataract was 52.6% for blindness and 20.6% for the visual impairment among people 40 years and over between 1991 t0 1993(Al Faran, M.F., 1993). Refractive error: this refers to optical imperfections which lead to the inability of the eye to accurately focus of the light coming from distance to the retina, causing unclear vision. There are three main types of refractive errors: myopia, hyperopia, and astigmatism. Worldwide, it is estimated that the prevalence of refractive errors ranges from 800 million to 2.3 billion (Holden, B., 2004). In Bisha, refractive error is responsible for about 67.9% of visual impairment (visual acuity3/60 with suitable correction in the better eye) among people 40 years and over (Al Faran, M.F., 1993). Strategic context-: 1-In 1993, only one main hospital with three primary health care services surrounded Bisha. Indeed, after more than fifteen years, it still has the same hospital (with accepted improvement in all health sectors) and nearly seven primary health cares with one a new private vision centre. In addition, most cataract and refractive errors cases are referred by primary health cares to the ophthalmic and optometry department within the hospital. This can lead to overload and a long waiting list for cataract surgery and doing refractive tests. In addition, some of patients travel to another city looking for a sooner appointment for cataract surgery. Therefore, the number of human resources should be increased including cataract surgeons, optometrist and trained eye-care persons such as nurses in remote areas as well as the vision centres. 2- The critical view toward Bisha city within the kingdom of Saudi Arabian indicates the main cause of increasing the visual impairment and blindness is due to a lack of health education sectors. Furthermore, there is no type of any source of information about the important of wearing glasses in refractive errors and post-cataract surgery, routine checking for vision and doing cataract operation as the doctor advises. In fact, little of the information is usually provided by eye teams such as ophthalmologists, optometrists and eye nurses during any short appointment. Aims and objectives: The main aim for this program is reducing the prevalence of the blindness and visual impairment caused by both cataracts and uncorrected refractive error among people 40 years and over in Bisha and rural cities. This will be achieved by some strategies such as increasing the awareness and establish a new vision centres within and surround Bisha. Target population According to available statistics the population of Bisha was around 90,749 in 1993 and at the end of 2010 was more than 170.000. According the number of health services in 1993 and 2011, there is still an inability to cover all eye cases as well as provide accepted management with this remarkable increase in the population number. Thus, the main objective of this grant is to provide strategies which limit the blindness and visual impairment among the most affected group - 40 years old and above. In fact, there is no statistic about the actual number of the people in this age group. However, because Bisha is an agriculture city and most of old people prefer to work and live in their farms, while most of young people looking for better life in the economic cities like Jeddah and Riyadh, this could be an indication that there are a large number of old people live in Bisha. The strategies: The main strategies are to raise the public awareness about the impact of uncorrected refractive error and cataract disease. In addition, producing an effective screening program and establishing suitable eye facilities as well as education and investing in training the eye care personnel including ophthalmologists, optometrists and opticians. The last important strategy is introducing an assessment team that can be maintained to help improve and prevent these optical problems. A: Increase the public awareness: Awareness about the impacts of cataract and uncorrected refractive errors among the target age group will play a significant role in reducing the burden of visual impairment. In fact, there are two organisations for health eye care in both Jeddah and Riyadh (both large, important cities in Saudi Arabia), while there is no particular government or non-government eye care organisation in Bisha. Therefore, the main step is exploiting all types of media with necessary information from the eye health sectors. Firstly, it is clear that educational sectors can significantly contribute to reduce the most common eye problems in the city. For example, creating a specific day as eye health day every three months in the first year (followed by an annual repetition of the same event) will help to achieve most objectives. This can be done by cooperation between both eye care services and the educational sector. Both teachers and students can distribute eye safety guides in case of refractive error or cataracts within all public services including schools (to hold this message for their parents and relatives in the over 40 group as well as help to reduce the vision problem among them in the future), shopping centres and within the transport industry. Secondly, the religious places play a crucial role as consequence of the weekly speeches and meeting hundreds of people at the popular mosques within and surrounded the city (Bisha, like many other Saudi Arabian cities, has more than one hundreds of mosque within the city and its suburbs). This is a great opportunity for spreading the word about eyecare, especially with co-operation between imams and eye-care specialists. This co-operation could help spread the message about the importance of eye-care and corrective lenses to the majority of the population. Furthermore, the media has a large influence on every society by encouraging or even changing opinions. For example, the eye-care sector can warn people via big electronic posters near important government and non-government places such as hospitals, banks and the agriculture ministry (Bisha is considered to be an agriculture city and most old people work in their own farms). Finally, because Bisha is a multi-tribal area and each group of them has a separate leadership (who responsible about the most of his individual’s problems and usually supported by the government), the eye health education can benefit by the direct connection with these leaders, inviting them to spread the message about the visual impairment and blindness problems among his tribe. This could be developed into routine visiting by any of the new eye-care teams in the usual tribal meeting places. All in all, the health and educational sectors as well as the tribal leaderships and religious places can play a vital role in education and raising awareness about eye health in Bisha’s community. B: Increase the number of vision centres: According to the previous information in 1993 and current data, it was clear there are a limited number of health services generally, as well as centres dedicated specifically to eye-care and visual health. Unfortunately, Bisha still only has one main public hospital, including a single ophthalmic department with a limited number of human resources: about four ophthalmologists and two optometrists. The program above aims to increase eye care centres inside and surrounding Bisha according to the cataracts and uncorrected refractive errors problems among the patients 40 years and above. The second way of developing this is to increase the number of vision centres as follows. Firstly, establish one particular centre for cataract surgery and post-cataract refractive error testing within Bisha. This can be achieved by providing at least two cataract surgeons with three optometrists as well as a suitable number the nurses. In addition, the health ministry, responsible for the duty of reducing and controlling any health problem, would be to provide all facilities including the appropriate building, equipment, essential medications, refraction facilities, hospitals beds for eye patients and operation rooms. More human power would also be necessary in the form of a manager and health teams. Meanwhile, to reach a high-quality of service, providing a specific place to receive the patient comments after, during and post treatment process which help this centre to achieve the most goals and contribute in future needed information about cataract and refractive error cases. Secondly, it would be useful to invest in the integration of primary eye cares within each primary health care in the remote area. That would be done by training the primary health-care workers to detect and diagnose the blind and those with visual impairment as well as referring patients to suitable eye care workers and provide appropriate treatment. In addition, supplying at least three primary health cares with the optometry workers to perform the refraction error conditions is necessary. There may be problems encouraging ophthalmologists and opticians to work here, not only because of the shortage of eye-care workers in Saudi Arabia but also because Bisha is not a desirable residency area for young people (who are more likely to work in this industry). However, if there are enough optometry cases, it could be considered with the most needy area according to number of referral cases by the primary health care workers. Thirdly, improving the ophthalmic and optometry department inside the King Abdullah Hospital would be hugely beneficial. This can be achieved by promoting eye-health service areas including their instruments, technology, infrastructure and the staff ability. Improving eye staff ability and increasing their knowledge by workshops within the hospitals or in Riyadh and Jeddah eye clinics would also be beneficial to this cause. Moreover, employing at least two cataract surgeons to deal with the large number of the patient with cataracts as well as increase the optometry staff number to at least four or five to cover all refractive cases and perform the refractive correction. Finally, encouraging profit and non-profit organisations to establish a numbers of optical shops within and surrounded Bisha would greatly benefit the eye health of the area. For those on low-income, the non-profit or charity organisations can distribute a number of boxes in popular places, encouraging people to donate their old glasses in order to replace them with suitable lenses for distribution to those on low-incomes. C: Effective program screening: There are two effective methods for vision screening for application by both eye health service and health ministry department in Bisha. Firstly, an extensive training program for about seven to ten nurses (for each primary care clinic) during two months about basic methods for checking vision (such as Snellan charts for detection refracted errors and ophthalmoscopes for recognised cataracts). These nurses can then refer all vision diseases to ophthalmologists and optometrists. These nurses can also carry out routine check every six months for all individuals 40 years and over. Secondly, in some developing countries such as United Arab Emirates, there are dentist transportation clinics, used for treatment students stopping ever week in every school throughout the study year. From this idea, it is possible to create a travelling vision clinic for two important roles; vision screening, treating simple eye problems (the prescription of corrective lenses), and the referral for more serious eye problems. This travelling vision clinic can stop in each remote area for a week and provide different eye services, from giving information to treatment. In fact, this way can also help people who cannot access to eye services because a remote area or unavailability of transportation methods as well as provide a simple examination for very old and disabled people. D: Introducing assessment team: In fact, the most a vital step for the success of any programme is the assessment and evaluation of all the strategies and activities among the planning process. Analysing feedback is very useful to promote the necessary steps enforced in order to achieve the above targets and objectives. Therefore, in this project, the organisation’s project management system will consist of three health workers to collect information regarding the prevalence of visual impairment and blindness among those 40 years and over. This can be done by survey in the first month and eight months after starting the project. This data will indicate both the negative and positive impacts, and also help to evaluate the aims and objectives that have been achieved as well as how the all health eye services work and if they are reducing the visual problems. In addition, evaluating the survey methods, including the nurses’ survey among remote areas and vision clinic transportation will help the scheme to succeed. At the end, analysing the data will be very helpful in developing new future programs as well as avoiding the negative aspects. Outcomes: 1- After the awareness activities, people 40 years and above would be have a good fundamental knowledge about the causes of visual impairment and blindness and what the impact of these conditions can be on everyday life. Due to this increased knowledge, they will start seeking treatment more frequently. 2- To establish sustainable resources of eye health treatment and health services including particular cataract centres, primary eye cares, the hospital service and the eyewear recycling scheme. 3- The prevalence of visual impairment and blindness will be significantly decreased among this group, and the quality of life for most individuals in the area will be improved. Timelines: In the first three months of the project, it is necessary to concentrate on: 1- Improving the ophthalmic and optometry department within the main hospital as well as starting provide increased numbers of cataract surgeons and optometrists. 2- Starting to establish the cataract centre within the city. 3- Establishing the two-month training program for nurses in the remote areas, and having the newly trained nurses record and refer eye-cases in the 40 years and older age group. 4- Starting to establish the vision transportation clinic, whilst at the same time doing the initial survey on this project. 5- Preparing for all awareness activities to collect information and guides about the vision problems, their impacts and their treatment. For example, preparing large number of printed papers, choosing the persons who contact within the education sectors, religious places, the tribal leaderships, as well as preparing their species is a good start. From four months to end of the year: (raising awareness among the all public sectors) 1- The health education sectors are now conducting the eye health day every three or four months. 2- The people responsible for the awareness scheme (chosen from eye health staff) have decided a rota of the popular mosques in which to give speeches about vision problems (around five to ten minutes talk) 3- The awareness step has been improved by contact with each of the different authorities. After eight or ten months: 1- A second response survey will be conducted. 2- The organisation’s project management system will collect the survey information as well as collect all patient comment from the health sectors to begin to analyse all the information and decide whether this programme is efficient and has achieved their objectives and aims. How integrate with general health care: The programme integrates with general health care by training the primary health-care workers to detect and diagnose the blind and visual impairment particularly in remote areas. Outline where and how optometrist fit into this plan? Optometrists play an important role in reducing uncorrected refractive error cases and post-cataract refraction. The total of number of optometrists needed in this project totals about ten, three in the cataract centre, three in primary health care, four in the main hospital and one working in transportation vision clinic. Is this program sustainable? This depends on the following points: - In case of the awareness strategies, success is related to advertisement in places including health education and mosques (most Saudi Arabians are Muslim and the Friday speech plays a crucial role in the development of any social, political or healthcare issues as thousands of people have to attend this day as part of their faith). - The health care clinics, including the travelling clinic and the new dedicated eye-care surgeries have to be well-funded and well-received in the communities - The circulation process between training nurses in the primary health cares and referrals to main hospitals or cataract centres needs to continue even after project ends. - Depending on the survey methods, the program can be expanded to include other eye problems which help other eye study related to existing eye diseases. References: 1- Steinert, RF 2010, Cataract Surgery, 3rd edn, Saunders Elsevier Inc, China. 2- Al Faran, MF, Al-Rajhi, AA, AL-Omar, OM, Al-Ghamdi, SA &Jabak, M 1993,” Prevalence and cause of visual impairment and blindness in the South Western region of Saudi Arabia”. International ophthalmology, vol .17,pp.161-165. 3- Al Faran, MF & Ibechukwu , IB 1993. , “Causes of low vision and blindness in South Western Saudi Arabia”. International Ophthalmology, vol .17, pp.243-247. 4- Ellwein, LB & Kupfer, C 1995, “Strategic issues in preventing catract blindness in developing countries”, Bulletin of the World Health Organization,vol 73,pp. 681-690. 5- Tabbara, KF& Blodi, FC 1987, “Opthalmology in Saudi Arabia”, Arch Opthalmology, vol105, June1987,pp.861-865. 6-World health Organization and Intrnational Agency for the prevention of blindness, 2004, Developing an Action Plan, toprevent blindness at national, provincial, and district levels,() Access in 19-9-2011. 7- Holden, B, Fricke, T, Naidoo, K, Hasan, M, Schlenther, G, Cronje, S, Hoare, P, Faal, H, Vincent, J Gilbert, C, Burnett, A, Wilson, D and Paudel ,p, “Strategy for The Elimination of Vision Impairment from Uncorrected Refractive Error”, (http://www.vision2020.org/documents/Committee%20documents/Refractive%20Error/REPComStrategy.doc), access in 16-9-2011. Read More