“Nayantara : An integrated mobile
service for treatment of diabetic
retinopathy in semi urban and rural
India
Dr. Mohita Sharma
Chief Ophthalmologist
Tirupati Eye Centre
Noida, India
India : home of largest number of
diabetics in the world
• WHO estimation of diabetes
135 million in 1995 to 300 million in 2025
• Indian estimation
18 million in 1995 to 54 million in 2025
(195 %)
• INDIA- largest diabetic population50.8 million (followed by China 43.2 million)
Indian Challenge
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•
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70% people live in rural areas
70 % ophthalmologists live in urban areas
Majority of diabetics are undiagnosed
UNDIAGNOSED CASES
2/3 in urban
¾ in rural areas
Uttar Pradesh
No population based surveys on diabetic
retinopathy
• Most populous
state
• 190 million
population
• 16.4 % of whole
population
Barriers for treatment of DR
Unable to perform/interpret
Equipment costly
FFA
LASER
45 %
60 %
71.25 % 71.25 %
Patients cannot afford
35 %
35 %
Number of patients doesn’t
justify investment
Instruments is/are
unnecessary
70 %
70 %
12.5 %
12.5 %
Solutions
• Share equipment
• A mobile van
• Sound economic model aimed at Sustainable
Charity
• Economic incentive for local doctor
• Offer free service for the poor
Project: Tirupati Eye Centre DR
Mobile Unit
•Diagnosis and treatment of DR and
complications
• 5 districts of Western UP
• Mobile unit
• Pre decided route map
• Local ophthal, GPs access to equipments
Mobile unit details
• Heat- AC- temp regulation
• Dust- air ionizer- dust free
• Electric power supplygenerator, UPS
• Voltage fluctuationstabilizers
Team in the mobile unit
•
•
•
•
Trained retina consultant
Optometrist
Paramedical worker
Driver
Work at mobile unit
Free of cost treatment to poor
patients and minimal charges to
those who can pay
Refuse treatment to none for want of
money
Sound economic model
• Minimal charges for those who can pay
• Earnings are shared between the local Doctor
(ophthalmologist/ physician) and the Project
• Physician/Ophthalmologist – Timely eye
treatment EARN WHILE THEY LEARN/TREAT
• Project income– SELF SUSTAINABLE
Target population
•231,402 diabetics
•Diabetic retinopathy 67,106 in this population
•Treatment would prevent 1735 people from
becoming blind
.
Training
• Ophthalmologist trained in retina on board
• Each participating ophthalmologist
individually trained on the stopovers
• Lot of enthusiasm to learn
CMEs/ training sessions with
lectures
Model eye laser session
• Doctors use the laser
machine to obtain
burns in the model eye
• Concept of spot size,
power, duration,
interval and its effect in
model eye are
understood
Doctors Training
AMC CME Date: 09th Oct 2010- Physicians
Training session : Local health
workers
Training sessions- Booklets
• Hindi and English
• For Doctors as well as lay public
Community participation- religious
organizations and clubs
Noida Diabetes Forum
Lions Club
Sai Temple
Diabetes Camp at Haldwani
What we have achieved
Achieved
Trained ophthalmologists
98
Trained GPs
142
Trained healthcare workers
102
DR screening
14565
FFAs
3830
Lasers
4689
Perimetries
3607
Lessons learnt
• Training most important aspect- retained interest of
ophthalmologists, GPs also need a continuous reinforcement
by training in steps:
1.
CMEs
2. Practical training- screening for DR changes on retina
• Regular training sessions-1 time training not sufficient,
assessment of the adequacy of training and capacity building
Training of “already trained”
ophthalmologists
Lessons learnt
• Semi urban areas- patients- paying capacity
not very low. Project has reached self
sustainability in 50% of its expenses
• Semi urban areas- ophthalmologists- low cost
lasers and FFAs
Challenges ahead
• Manage the running costs by income
generated on the van
• Replace van and equipment periodically
• Add on new districts to the area of coverage
• Replicate the design in other parts of India
and the world
Conclusion
• Empowering local community/professionals to
access quality care, skills and knowledge
• Taking superspeciality care for treatment of diabetic
retinopathy to the unreached
“ If
you want to feed a man for one
day, serve him fish. If you want
to feed him for life, teach him
fishing”
Thank You For Watching This
Presentation