Saturday 11th August (Part 1)

This morning began with a briefing at the Country Office

Blindness in Bangladesh is overwhelmingly caused by cataract – the recent national blindness survey showed 80%.This seems to be a much higher proportion than anywhere else I have visited. There is a considerable amount of refractive error (people who require glasses) and low vision – this often overlaps with cataract. Diabetic retinopathy (blindness caused by diabetes) and glaucoma are clearly problems which will become significant in the future, but at the moment cataract dominates.

As always seems to be the case, the ophthalmologists are concentrated in the urban areas whilst 80% of the need is mainly in rural areas. Around half the ophthalmologists are in government hospitals and half in NGO hospitals (a small no in private hospitals), but 86% if cataracts are performed in NGO hospitals and only 10% in government ones. This rather shocking statistic is caused by a number of factors, including lack of training, lacking of mid level eyecare personnel and lack of equipment. Wherever we went during the trip, people were dismissive of the possibility of the government hospitals ever functioning properly. Nonetheless, it is my view that we should not be deterred from our long term goal of developing the government sector, not just the NGO sector.

It is particularly concerning to hear that the government has set aside £300k to spend on eyecare, yet it cannot seem to do this because of lack of management. This is despite having a Vision 2020 committee led by the Director General of Health, a separate directorate for eyecare and a National Eyecare Plan. Clearly a priority needs to be providing support to enable them to spend this budget properly (and keeping up the pressure them to do so).