The CEF NRHM Prevention of Blindness Project 2009 - Kumarakom Camp

The kumarakom camp was held on 11th January 2009. The camp was organized by the Cochin Eye Foundation and Ranjini Eye Hospital in association with the National Rural Health Mission and the SN club, Kumarakom. The contact person from SN club was Mr. Surendran Virippukala.

The camp site was in Virippukala, Kumarakom; approximately 60 Km from the base hospital. It was held at the SN auditorium.

The staff and doctors of REH and CEF assembled at REH at 7.15 in REH. A Tempo Traveller minibus was hired for transporting the equipment and staff to the camp site. The rental for the vehicle was Rs. 2000/-. After loading everything into the minibus, we left the hospital at 8.00 am. Dr. Anju and Dr. Santha along with the REH staff travelled in the Minibus. The doctors, KK, Piyush and the rest of the team left in 4 cars. This was the first camp we took the Perkins tonometer, the Ascan and Keratometer. Of course, like always, we had taken the slitlamp, indirect ophthalmoscope and the autorefractometer. Travelling through Tripunithura and Vaikom and alongside the serene backwaters of Kumarkom we reached the camp site. The road leading to the site was narrow and we were apprehensive about the minibus. But the driver along with the help of Sasi chettan, our driver, effortlessly navigated the route to come right in front of the auditorium. We were greeted by the organizers and were saddened by the news that one of the main organizers of the camp passed away that morning. Mr. Surendran Viruppukala informed Mr. Chandran, our camp coordinator about the excellent publicity he had given for the camp and also showed us that morning edition of the daily – the front page was an article by Dr. NSD Raju and there was a prominent advertisement about the camp.

We were little apprehensive about the area provided for the camp. It was a small auditorium and we had to accommodate the initial vision screening area, the doctors room, the refraction room with the computerize autorefractor, the Ascan and Keratometer. To complicate matters further, we needed room for applanation (Perkins) tonometry and dilated evaluation. Finally the confusion was sorted out (at least we thought so) and arranged the rooms well. But then we needed a place to have the multimedia patient education program (Patient education by doctors – multimedia presentations with videos – projected from the laptop using an LCD projector). Initially it was thought we will have the lectures on the inaugural stage, but the place was too bright and the screen could not be clearly seen. So we decide to have the patient education program in one corner of the auditorium. Another corner of the hall was getting ready for the general check up – blood pressure and blood glucose monitoring. Ms. Jyothi, our OR nurse and Mr. Rajesh from Novartis, were at the general check up area. An optical outlet was also arranged by the organizers and the team from Interoptics optical has set up shop just at the exit.

The formal inauguration was over. The prominent local politicians and panchayat presidents spoke at the inaugural function and wished the camp all success. We were ready. But where are the patients????

The Camp
We had reached Viruppukala at 9.00 am, finished setting up by 9.45 am and were ready to start the screening and evaluation of patients. But there weren’t many patients. We were worried. After travelling such a long way with all the equipments (not to forget Rs. 2000/- as rental for the minibus), if we did not see at least 250 patients it would be a wasted effort. Nevertheless we started off and slowly the crowd started trickling in. Word spread that the camp was unique. The people of Kumarakom had earlier witnessed 3 camps by the Aravind Hospital, Coimbatore. The Aravind camp is purely a cataract screening camp and for them nothing else is important. Therefore patients are screened with torch light and selected for surgery. They come to Kerala with minimum personnel for the camp – a junior doctor, couple of paramedical staff and a camp coordinator. The quality of care and the compassionate approach is what sets the CEF camps apart. The folks at Viripukkala were amazed at the technical expertise and the technological capabilities of CEF. It was as though a state of the art eye hospital was functioning in this remote rural area of Kerala. Slit lamp evaluation of the anterior segment, indirect and biomicroscopic evaluation of the retina, computerized refraction, Ascan biometry, Applanation tonometry, blood glucose estimation and multimedia patient education – this is more than what a full fledged eye hospital offers. Approximately 1 hour after we started, there was hardly any place to move around. The hall was packed and we were doing well.

Dr. NSD Raju started the patient education program. He spoke so lucidly about cataract. Dr. Anju then spoke on the general aspects of eye diseases. Dr. Biju spoke on Diabetic retinopathy. The videos and animations were well appreciated and the education program was successful. On the other side of the hall, KK Bhammer and Chandran sir were busy guiding patients to the doctors room and towards the investigations area. This was the first time we had Ascan biometry done at the camp site itself for the selected cataract patients. This was done to avoid multiple visits for the patients to the base hospital. Once the Ascan biometry and the general check were done, the patients were given a date for surgery at REH. Ms. Joemol, the patient services in charge, REH was busy making sure that the patients for surgery are distributed equally so that the hospital’s capacity is not pushed beyond its limits. Those requiring medicines were provided medicines free of cost at the camp site. Before the lunch break, the slit lamp’s bulb fused. We did not have a spare one. Mr. KK Bhammer made it a point to discuss in the CEF meetings to have an additional spare bulb for the slit lamp.
We took a break at 2.00 Pm for lunch. The lunch was at one of the organizers house and it was a wonderful feast. There was the famous Kumarakom Pearl spot fish fry and it was very tasty. We finished lunch and got back to the camp at 2.45 pm. There were about 50 patients waiting for work up and refraction. By the time we finished, it was 4.00 pm. We had seen 340 patients and selected 36 patients for surgery and 2 patients were for retinal surgery. Raju Thappar, a Nepali, working in one o f the rubber estates in Pala, heard about this camp and that retinal surgeries will be done free of cost when he visited Alphonsa Eye Hospital, Pala. He was told to have a retinal problem and the prognosis was bad. His right eye was blind and he was desperate to get some vision after treatment. Indeed, he was hoping for a miracle.

We packed all the stuff and started the long journey back at 4.30 pm. All of us were tired. The weather was hot and towards the end there was one patient whose registration card was missing and we had to look all over the place to find it. We reached REH at 6.00 pm. All the equipment was unloaded carefully and all of us called it a day, a very satisfying day.

The Surgeries
The surgeries started on 14th January and Raju Thappar came to REH on 15th January for intravitreal injection. He was diagnosed to have retinal vasculitis with vitreous hemorrhage in the right eye. On examination, it was found that his left eye also was showing early signs of vasculitis and there were new blood vessels. He now prayed hard for a miracle. What if his left eye also had a bleed? For this 20 year old labourer, the thought of going blind in both eyes was depressing.

One week after the injection, Raju Thappar underwent vitrectomy with membrane peeling and endolaser for the right eye. The membrane was difficult to remove and proved to be a real test of skills for Dr. Biju, the retinal surgeon. After surgery he was admitted at Welcare Hospital. All the patients from this camp were admitted at Welcare Hospital for 1 day as they could not travel back home the same day. Dr. Sachidananda Kamath of Welcare Hospital was kind enough to subsidise the charges for the camp patients and CEF took care of this expenses. Many of the camp patients could not believe that the entire procedure would be done free of cost. Previous camps by some other hospital used to charge the patients Rs. 3000 to 5000/- for the procedure. But as promised, none of the patients who turned up for surgery at REH had to spend a penny at the hospital. For Thappar, this meant a lot. Vitreoretinal surgery is very expensive (usually Rs. 20000 and above) and without CEF NRHM project, the fate of his eye was precarious! The next day when Dr. Biju removed the patch, Raju Thappar could see upto 3 meters. His preoperative vision was hardly any and this was a significant visual improvement. But that was just the beginning. The miracle was slowly taking shape. His visual acuity improved to 6/6 at 1 week and was as good as the left eye. All of us were astonished!! This was indeed a miraculous outcome. And of course, the patients who underwent cataract surgery were very thankful for the good outcomes and for helping them regain the precious gift of sight.

The camp at Kumarakom was a grand success. We are getting requests from the nearby areas for organizing eye camps. The organizers were really impressed and were proud that a hospital in their own state is doing a great job. They have invited us for lunch and a boating trip on the backwaters. We are planning to combine this with the postoperative visit where we will be providing glasses free of cost to surgical patients.