ORBIS’s pediatric eye care project in Baotou, Inner Mongolia 2008 Q3 & Q4 Progress Report Period covered: June 16th – December 31st, 2008 1. 1. Capacity building 1.1 Third hospital-based program (HBP) The project’s third HBP was held at Bao Tou Eye Hospital (BTEH) between July 21st and July 25th last year. Its key focuses were strabismus 斜視 and amblyopia 弱視. In all, some 45 eye doctors and 20 other medical professionals from BTEH and its project sites benefited from this training. ORBIS volunteer faculty (VF) member, Dr Paul Otis, from the US not only trained young doctors via lectures, but also demonstrated both typical and difficult surgeries that provided hands-on training for trainees. The key objectives of this HBP’s screenings, surgeries and lectures were to: Describe basic features of dyslexia 描述誦讀困難的基本特徵 Describe and utilize non-surgical treatments of strabismus and amblyopia 描述和 運用斜視和弱視的非手術治療 Demonstrate the most advanced techniques for assessing visual development among complicated or non-co-operative pediatric patients 掌握複雜或不合作兒童 眼科患者的最高級視力發育評估技巧 In all, some 60 patients were screened and 10 surgeries were performed by Dr Otis with the assistance of local doctors Dr Ma Liping 馬麗萍, Dr Chen Xiaoling 陳曉玲 and Dr Hou Liwen 侯利文. During these operations, Dr Otis shared on-the-job surgical explanations and advice that gave his local counterparts valuable practical insights into the many topics covered in his daily lectures. Feedback from the trainees was very positive. Normally the patients selected by ORBIS VF members for training are typical cases, but this HBP selected several more complex cases. The trainees were very impressed by the management plan, the various ways of dealing with difficult conditions and each treatment’s positive results. Steps used in diagnosing and managing cases have also proved to be very useful in trainees’ daily work. 1.2 Training of medical professionals Three-month fellowship in India Between October and December 2008, Dr Chen XiaoLing and Dr Hou Liwen completed respective three-month fellowships at LV Prasad Eye Institute (LVPE) and Goutami Eye Institute in India in the field of pediatric ophthalmology 小兒眼科 and cataracts 白內障. Having learnt the most updated skills for diagnosing and treating pediatric congenital disease 先天性小兒眼 疾 and retinopathy of prematurity 早產嬰兒視網膜病變, Dr Chen was able to fully participate in screenings and case discussions. In performing some 200 small incision cataract surgeries in Goutami Eye Institute, Dr Hou exceeded the number of procedures he had undertaken in his career up to that point. The two doctors both returned to Baotou extremely impressed by the highly efficient, high volume and quality eye care services they witnessed in India. Each doctor subsequently shared his experience, knowledge and skills at a project mobilization meeting in January 09. As the respective heads of pediatric and anterior ophthalmology 眼前節, the two doctors’ enhanced competency will be critical in ensuring BTEH can provide high quality patient care and transfer knowledge and skills to young doctors. Hospital-based training Between April and December 2008, five doctors from the rural eye care network successfully completed hospital-based training in basic general ophthalmology and pediatric eye care knowledge and skills at BTEH. After training, each doctor was able to manage certain conditions, identify patients needing referral and provide patients with important eye care information. Period Name Responsible unit Apr-July Dr Guo Xiaobin Siziwang Qi County Hospital 郭曉彬 四字王旗縣醫院 Dr Du Xueqin 杜雪琴 Dr Wang Wenjing 王文靜 Dr Liang Junfeng 梁俊峰 Dr Liu Meizhao 劉美召 Dongsheng People’s Hospital 鄂爾多斯東勝區人民醫院 Shaerqin Township Clinic 沙爾沁鄉鎮中心衛生院 Siziwang Qi County Hospital 四字王旗縣醫院 Maodai Township Clinic 毛岱鄉鄉鎮中心衛生院 July-Dec July-Dec July-Dec July-Dec Launch of Inner Mongolia’s first ever wet lab In addition to assisting their mentors in diagnosing patients at the clinic and helping with surgeries in the operation theatre, trainees also received lectures and practiced in BTEH’s new wet lab 模擬手術室 which opened in September 2008. In February 2008, BTEH appointed Deputy Director, Dr Bian Hongxia 邊紅霞, to oversee training. Her specific activities included designing and arranging theoretical and practical training sessions at the wet lab. All new/junior doctors and even their counterparts from other local hospitals are free to use the wet lab and practice cataract surgery on pig eyes for free. The first facility of its kind in Inner Mongolia, the wet lab offers young doctors a wonderful opportunity to sharpen their surgical skills and thus helps enhance the overall quality of eye care services. National retinal training workshop Between November 27th and December 4th, 2008, BTEH’s Dr Bian Hongxia and Dr Wu Yongsheng 鄔永生 attended a national retinal training workshop hosted by the Chinese Ophthalmic Society, Retina Group in Shanghai. Diabetic retinopathy (DR) 糖 尿病視網膜病變 and age-related macular degeneration (AMD) 老年黃斑病變 were identified as being key topics for early intervention at these sessions. New advancements in DR and AMD medical management and surgical skills in dealing with these two conditions were also shared during this workshop. Ultimately, some 100 doctors nationwide benefited from presentations by the Chairman of Chinese Ophthalmic Society. Other influential retinal authorities from Beijing, Shanghai, Guangzhou, Hangzhou and Chengdu also gave presentations, chaired case discussions and gave surgical demonstrations during the week. “Training the trainer” workshop 52 participants from BTEH and its neighboring rural eye care network attended this December 8th to 12th, 2008 workshop. On the first two days, “Training the trainer” was the main topic. The focus was how to best design and deliver pediatric eye care training to community doctors after assessing patient needs. Teaching tests and comments were also rehearsed. The next two days covered practical training for the community doctors. The content was simple, straightforward and easily applicable to each doctor’s daily work. 1.3 Recruitment of new staff To date, BTEH has almost doubled its service numbers in terms of outpatient visits, medical treatments and surgeries since investing in community-based activities such as eye health education and free screenings. In order to cope with the resultant unprecedented increase in large-scale community activities and patients, BTEH hired an additional 12 undergraduate doctors and 10 nurses. 1.4 Implementation of phoroptors 綜合驗光儀 Seven phoroptors were purchased in 2008 and been operational since June. BTEH and its co-partners were very proud to have these phoroptors as such equipment is generally not found in other hospitals. BTEH medical staff are now using the machines to provide high quality optometry services for local children. Three more phoroptors will come on line in 2009. 1.5 Inspiration from Stanford University Between November 13th and 18th, BTEH welcomed an intern from Stanford University in the US who assisted Director Ma in diagnosing patients at the outpatient clinic. The intern’s other responsibilities included observing surgeries in the operation theatre, participating in community outreach activities and consulting on eye health education. The intern also taught young doctors in the wet lab and presented research studies. His visit proved an excellent example of how eye care-related knowledge and skills and even culture, education and health care system practices can be shared between China and the US. 2. Community eye care activities 2.1 Co-operation with local public health bureau BTEH is now the only facility in Baotou to offer poorer patients an easily affordable scaled pricing framework. For cataract patients identified in the community the maximum charge is RMB800. BTEH is also collaborating with the local government in performing subsidized surgeries for poorer families. To date, some 150 free and 114 low-priced surgeries have been performed on patients who would otherwise have had no hope of regaining their sight. Touchingly, BTEH staff rallied around and generously donated the funds that enabled an impoverished child with congenital cataracts to receive surgery on both eyes (please refer to the patient story in section 5). BTEH is now very probably the Inner Mongolian leader in safe, speedy, affordable small incision surgery for cataract sufferers. The fact that BTEH is coping so well with its encouraging patient increase is further motivating staff to get involved in community outreach activities and provide muchneeded technical support in rural areas. Leveraging the platform ORBIS and its donors have provided, BTEH is doing everything possible to mobilize and integrate all eye care-related resources from local government and health authorities and neighboring disabled federations and social resources. The ultimate aim is to ensure eye care services are easily affordable and accessible by even the poorest person. 2.2 Collaborative community screenings BTEH continually conducts community-based eye disease screenings and is expanding these activities into more and more communities and schools. At the same time, eye care information is being distributed to the public and parents. Before the project became active, the local community lacked confidence in BTEH and rarely visited the hospital or its eye care network for follow-ups or treatment. Nearly two years after project implementation, BTEH has cemented its reputation for providing affordable top quality optometry and pediatric and other eye care services. While still more people are now actively seeking treatment at BTEH, many visuallyimpaired people remain reluctant to use the services because of financial difficulties. By offering low-income adults and children lower prices for services such as refraction, optometry, strabismus, and surgical management, BTEH has transformed the lives of many poorer patients. BTEH is also continuing to organize largescale community eye care activities. Specific examples include community eye care lectures, live “Q & A” sessions on eye care knowledge, eye care phone-in hotlines to local radio stations and eye care promotion in all local newspapers in the run up to October 2008 World Sight Day. During Q3 and Q4 of 2008, BTEH conducted pediatric eye screenings in 32 kindergartens and 18 primary schools in Baotou. As a result, many eye conditions were identified early and treated before long-term damage was caused. As awareness of the importance of protecting one’s sight has also significantly increased, we are confident blindness occurrence rates will continue to fall steadily. 3. Medical achievements During the second half of 2008, the project’s key achievements included: Number of doctors trained Number of patients examined Number of patients who received medical treatment Number of eye surgeries performed 106 21,098 adults; 23,724 children 12,680 adults; 8,616 children 7,024 adults; 726 children Number of people educated about protecting their sight (via 60,000 eye testing activities, eye care lectures, out-patient consultations, etc) Number of people informed of the importance of protecting 600,000 their sight (via media advertising/ news reports and the distribution of “information, education & communications” materials, etc) Sharing mission In August 2008, a rural worker called Li Ke-xing from a village in Guyang County brought his 8month-old baby Li Dong-sheng 李東升 to BTEH for an eye check up. Sadly, little Sheng was found to suffer from congenital bilateral cataracts 雙眼先天性 白內障, nystagmus 眼球震顫 and esotropia 內斜視. BTEH’s doctors recommended immediate surgical implantation of an intraocular lens to save the baby’s sight. Having recently sold almost everything he owned to pay for his wife’s battle against cancer, Li was devastated to discover his son’s life transforming operation would cost RMB10,000. Fortunately, BTEH Director, Dr Ma, strongly believed that “Little Sheng was just too young to be abandoned to his fate”. Having been ORBIS’s local partner and shared our sight-saving vision for several years, Director Ma generously decided to waive all the necessary fees. Li was deeply touched when told of Director Ma’s kindness. A week later, little Sheng became the youngest-ever patient to undergo an operation at BTEH. To minimize risks caused by the baby’s age and size, BTEH devoted its best medical staff and facilities in the battle to save Sheng’s eyesight. Little over a month later, Little Sheng had made a full recovery and was able to begin a new life full of hope, blessings, and joy.