Fighting blindness in Bangladesh

As with many of our long-term country programs, capacity building plays a key role in improving eye care in Bangladesh. We have improved the skills and knowledge of local partners with a particular focus on pediatric eye surgery, microsurgery, retinal surgery, and eye banking. Orbis offers a "blended" approach to learning which includes remote training via Cybersight, in-person training in local hospitals, and fellowships, to ensure local partners get the most out of our training partnerships.

Our programs have a particular focus on tackling the sight-threatening conditions of retinopathy of prematurity and diabetic retinopathy. We are also working with the displaced Rohingya community in Cox's Bazaar as part of a humanitarian relief effort.

With only 1,200 ophthalmologists, Bangladesh faces daunting challenges in delivering quality eye care to its population of 164 million people. Across the country, 750,000 adults and 48,000 children are living with blindness.

REFRACTIVE ERROR AMONG CHILDREN

The Refractive Error Among Children (REACH) project aims to reduce visual impairment due to uncorrected refractive error among school-going children and provide a sustainable and scalable solution to a shortage of care.

Orbis, along with our partners, develops teams of ophthalmic personnel and supports them with digital and clinical equipment to perform screenings in schools, and provide eyeglasses, as well as referrals for children who require further examination and treatment. This model has also been rolled out successfully in India, Ghana, and Nepal.

RETINOPATHY OF PREMATURITY

To improve the quality of eye care available to Bangladesh's 65 million children, Orbis is expanding screening for retinopathy of prematurity, a potentially blinding disease that affects premature infants, and is the leading cause of blindness among children worldwide.

With the right awareness, knowledge, and equipment, however, retinopathy of prematurity is entirely preventable. Most hospitals in Bangladesh are not equipped for screening and treatment, which is why we're working with the Bangladesh government, NGOs, and local partners to improve the quality of eye care parents can access for their premature children.

In particular, we're training neonatal intensive care unit nurses and ophthalmologists and improving standards of ophthalmic facilities so that infants can get the treatment they need. We're also providing education and awareness at the community level for parents, as well as building awareness among local healthcare providers and general practice doctors to increase the chances of retinopathy of prematurity being detected and treated in time.

Alongside our partners, we also played a leading role in establishing Bangladesh's first national guidelines on retinopathy of prematurity management.

DIABETIC RETINOPATHY

To combat diabetic retinopathy we helped establish Bangladesh's primary Retinopathy Referral Network. Backed by the World Diabetes Foundation, with support from local health and eye care partners, the project was officially launched by former CEO Bob Ranck in 2019. The project is designed to create a scalable integrated model to improve eye care services for diabetic patients in five rural districts. The referral network has been supplemented by vision units designed to serve children with diabetes.

The number of diabetic eye diseases and associated blindness is increasing every year because so many people with diabetes are going undiagnosed, and even when their illness is identified, those affected lack access to the right type of eye care.

We have been working in collaboration with Changing Diabetes in Children and Life for a Child to implement comprehensive cover for children with diabetes.

VISION CENTERS

Orbis has supported the development and set-up of 36 vision centers and four women-led Green Vision Centers. The vision centers are the primary eye care facilities that connect communities with eye hospitals. Each vision center has a team of ophthalmic personnel, trained to recognize eye diseases, conduct refraction, provide eyeglasses, and refer patients to eye hospitals for more complicated problems. The vision centers also conduct awareness-raising activities, outreach camps, and eye testing programs in schools to promote eye care services in remote and hard-to-reach communities. Each vision center has a catchment population of around 100,000 people.

GREEN VISION CENTERS

Green Vision Centers are an innovative approach that not only improves the quality of eye health in communities that have traditionally lacked access to care but also operates with sustainability at the forefront. The centres run on solar power, a solution that is environmentally friendly and helps to overcome challenges caused by frequent power outages, ensuring that eye care remains uninterrupted regardless of access to electricity.

By being women-led, the centres also address a variety of traditional barriers for women and girls. Orbis trains women-led management teams to run the centres, empowering women in the community through job creation and increasing their financial independence. An added benefit of having female staff is that many women in rural communities in India are more likely to seek eye care for themselves and their children when it is administered by other women.

Orbis has helped establish four Green Vision Centres, with each centre reaching around 100,000 people.

We’ve conducted screenings of around five million adults and children and have provided treatments to nearly 3.7 million people. We helped establish 10 paediatric eye care centres in Bangladesh, 22 vision centres in remote and under-served areas, 1,000 community-based outreach programs, and the country’s first modern eye bank. We also contributed significantly to developing the National Eye Care plan under the Ministry of Health and Family Welfare, which has been incorporated by the government.

SUPPORT FOR THE ROHINGYA COMMUNITY IN BANGLADESH

Thanks to support from the Qatar Fund for Development and Baitush Sharaf Eye Hospital we have been providing vision screenings, glasses, and cataract surgery for children and adults in the Rohingya population and surrounding host communities in southeast Bangladesh since February 2018.

Kutupalong, the world’s largest refugee settlement, is in Cox's Bazar, where hundreds of thousands of Rohingya refugees from Myanmar now live. Orbis, together with our local partner, runs one vision center in the refugee settlement and another outside the settlement for members of the host community. Thanks to these partnerships, Orbis was able to deliver more than 127,000 eye screenings and nearly 52,000 treatments to the Rohingya population and host communities in the first two years alone. The work is continuing at pace with more impact data coming soon.

A study undertaken by Orbis and Baitush Sharaf Eye Hospital took place between February 2018 and March 2019. In this time over 48,000 Rohingya and more than 20,000 local residents underwent vision screening at vision centers in the camp and surrounding districts.

The results of the screenings showed that blindness was three-to-six times more prevalent in the Rohingya population compared to the local residents. Rohingyan patients ages 18-39, peak working age in the community, suffered blindness at a rate more than three times the local residents–highlighting the economic stress and heavy burden of eye disease among the Rohingya population.

The Orbis Flying Eye Hospital first touched down in Bangladesh in 1985 and kick-started the first training programs for optometrists and opticians. To support long-term projects, we created a permanent office in Dhaka in 2000.

Over the years, we’ve made tremendous progress combating avoidable blindness. By working closely with 23 partners in 28 districts, we’re reaching more than half a million people each year. Since that first visit, we’ve trained more than 36,000 medical professionals in ophthalmic specialties including paediatric ophthalmology, retina, cataract, glaucoma, and cornea.

Since we began working with partners in Bangladesh Orbis has:

• Hosted 10 Flying Eye Hospital projects
• Equipped 400 community clinics with vision screening equipment
• Set up nine centers for diabetic retinopathy screening at district hospitals
• Supported the establishment or improvement of:
  • 17 secondary hospitals
  • Four tertiary hospitals
  • 32 vision centers
  • Two wet labs
  • One Quality Resource Center
  • Published six research papers in peer-reviewed journals in 2020-2021 alone

Orbis Bangladesh is working with 23 partners to help:

• Expand pediatric eye care services including retinopathy of prematurity
• Strengthen community and facility-based primary eye care services including school eye health
• Promote eye care for all with a focus on women, girls, people with disability, and displaced populations
• Strengthen service delivery of local eye care teams through an integrated approach, capacity building, simulation-based training, hospital-based training, and technology-based training
• Generate evidence through program data and research for improving quality of care, policy, and for use in advocacy

We work to promote quality eye care and best practice in eye health in collaboration with government, international and national NGOs. Below is a list of some of the fantastic institutions we work alongside.

Public/Government

• National Institute of Ophthalmology and Hospital (NIO&H) – Government apex institute and hospital under the Ministry of Health and Family Welfare

Non-profit Organizations/NGOs

• • Alliance for Cooperation and Legal Aid Bangladesh (ACLAB)
  • Bangladesh Diabetic Association (BADAS) – the network of over 54 diabetic hospitals across the country
  • Bangladesh Jatiya Andho Kallyan Samity, Comilla
  • BRAC
  • BNSB (Bangladesh National Society for the Blind) Hospital in Khulna
  • Chittagong Eye Infirmary & Training Complex (CEITC)
  • Cox's Bazar Baitush Sharaf Hospital
  • Deep Eye Care Foundation, Rangpur
  • Dr. K. Zaman BNSB (Bangladesh National Society for the Blind) Eye Hospital in Mymensingh
  • Gausul Azam BNSB (Bangladesh National Society for the Blind) Eye Hospital in Dinajpur
  • Grameen GC Eye Care Hospital, Bogra
  • Ispahani Islamia Eye Institute & Hospital (IIEI&H), Dhaka and its district level branch hospitals
  • Mazharul Haque BNSB (Bangladesh National Society for the Blind) Eye Hospital, Chandpur
  • Moulvibazar BNSB (Bangladesh National Society for the Blind) Eye Hospital
  • Voluntary Association for Rural Development (VARD), Sylhet