[Annual Reports] [Home]

Annual Report 2005

[PDF-File 245 KB]

HIGHLIGHTS 2005

59,808 Surgeries

[Outpatients and Surgery] [Special Services] [Outreach Activities] [Teaching and Training] [Miscellaneous] [Acknowledgements] [Up]

Outpatient Visits:

Special Services at SCEH, Lahan

Vitreo-Retinal Department:

Since 2004 a Phaco-Vitrectomy unit (OERTLI OS-3) , a ZEISS Operating Microscope (Visu 160) with BIOM / Inverter and a TOPCON Fundus Camera were added as special equipment.

The Vitreo-Retinal specialist Dr. Chirag Bhatt joined SCEH end of May 2004 and Dr. Bernd Fassbender, CBM Ophthalmologist and Vitreo-Retinal specialist from Germany, in February 2005. They performed 711 vitreo-retinal surgeries and 652 retinal laser procedures in 2005.

To make these services affordable, vitreo-retinal surgery including endolaser, silicon oil etc. is provided for only NPR 2,500 (USD 35).

Paediatric Department:
8,156 Children were examined at the base hospital. 1,413 underwent surgery, out of which 741 were cataract surgeries, nearly all of them with IOL implantation.

Corneal Ulcer Department:
1,815 new patients with corneal ulcer received treatment according to the lab findings.

Low Vision Department:
719 patients with low vision were assessed, including 190 children. They received special low vision devices and counselling.

Services to incurable blind:
Counselling services were provided at the base hospital to 417 blind persons, including 62 children.

Surgery:

Cataract total		51,458
Sutureless ECCE/IOL	43,003
Sutured ECCE/IOL	2,173
On children	741
Phacoemulsification, ECCE/IOL	4,035
Combined Cat. + Trabeculectomy	896
Other lens removal procedures	610
Trabeculectomy		1,065
Dacryocystorhinostomy		461
Dacyrocystectomy		740
Vitreo-Retinal Surgery		711
Scleral Buckling	105
Vitrectomy	606
Others		3,287
Laser procedures		2,086
Retinal Laser	652
Trans scleral cyclo photo-coagulation	303
Nd. YAG capsulotomy	867
Nd. YAG iridotomy	264
TOTAL (incl. 2,297 done at Satellite Hosp. Malangwa, 109 in Eye Camp in Diktel + 154 minor surgery in Satellite Clinic Rajbiraj)		59,808

Cataract Surgery:
51,458 cataract operations were performed in 2005, most of them (43,003) with sutureless Fishhook Technique.
Phacoemulsification was integrated into high volume surgery and increased to 4,035. Phaco surgery was not used as income generating activity, but performed without extra charges on selected patients, especially younger ones, with less mature cataracts.

Subsidy to poor patients:
95% of all patients pay a total of NPR 900-1,100 (USD 12.65-15.45) for major surgery.
3,470 poor patients presenting at the SCEH or in the Screening Camps, mainly from Nepal, received subsidized or free treatment, with SCEH subsidizing the total of NPR 1,440,312 (USD 20,230).

	Distance from Lahan	Frequency	Patients examined
Satellite Eye Clinic Rajbiraj	35 km	daily	16,081
Satellite Eye Clinic Siraha	40 km	3 x / week	6,189
Satellite Eye Hospital Malangwa	120 km	daily	12,329
PECC in Diktel, Khotang District	4 days' walk	daily	1,467
Cataract Screening Camps: 122			24,215
TOTAL Outreach Patients:			60,281

Satellite Centres:
In all Satellite Eye Centres patients are seen and treated or referred to Lahan by experienced Ophthalmic Assistants.

• In Rajbiraj a Lahan ophthalmologist is visiting for special treatment and minor surgery.
  
• Satellite Eye Hospital in Malangwa
  Although in this Satellite Eye Hospital surgery is performed only once a week by a Lahan ophthalmologist, the number of surgeries done in 2005 reached the total of 2,297, which means an increase of 41 % compared to 2004.
  
  

Primary Eye Care Centre in Diktel, Khotang District:
In the Primary Eye Care Centre (PECC) in Diktel of Khotang District, established in April 2004, one Ophthalmic Assistant along with a trained local Eye Worker provides outpatient services to the patients of this remote hill district of Sagarmatha Zone. In 2005, 1,467 patients were examined and treated or referred to Lahan if necessary.

Surgical Eye Camp in Diktel, Khotang District:
The annual Surgical Eye Camp was organized in the District Hospital of Diktel from 6th to 8th April 2005. During these three days, Dr. Rajan Rana, a senior ophthalmologist of SCEH, and a team of 5 SCEH staff examined and treated 447 patients and performed 109 operations, mostly on cataract. Mr. Rabindra Lal Choudhary, the Vice Chairman of Nepal Netra Jyoti Sangh, Siraha Branch accompanied the team.

School Screening & Xerophthalmia Surveillance Programme:
7,867 children were screened in 34 schools for eye defects and 25 were referred to SCEH Lahan for special refraction. 30 children found with Vitamin A deficiency received Vitamin A capsules.
According to the findings of the school screening, 15 villages were surveyed for children with Vitamin A deficiency.

Besides continuous medical education for the centre's ophthalmologists the following special teaching and training programs were performed:

3 Residents from BP Koirala Institute of Health Sciences, Dharan, each attended a one-month comprehensive clinical and surgical training.

In preparation to revive the cooperation with the Residency Programme of BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) Kathmandu, 4 Faculty Members stayed 3-4 weeks each at SCEH Lahan. From January 2006, always one of these Faculty will train and supervise 10 Residents at SCEH in batches of two for two months.

SCEH is co-sponsoring Dr. Lila Puri from Nepal for his three-years Residency in Ophthalmology at BPKLCOS Kathmandu since 28th April 2005.

Ophthalmic Assistant Training:
7 SCEH candidates passed the Ophthalmic Assistant (OA) Exam in December 2005 after three months' theoretical training at Ran-Ambika Lumbini Eye Hospital (RALEH), Bhairahawa and three years' practical training at SCEH Lahan.
One OA trainee, after three months at RALEH, is now undergoing his practical training at SCEH.
A new batch of 2 OA Trainees will return to SCEH for continued practicaltraining after one year of training at Himalaya Eye Hospital in Pokhara.

National Skill Certificate for Eye Health Workers:
The Council for Technical Education and Vocational Training (CTEVT) and its National Skill Test Board developed National Occupational Skill Standards and Tests for Eye Health Workers in order to recognize them with a National Skill Certificate.
43 Eye Health Workers (42 from SCEH) underwent a 2 ½ months refresher training at SCEH from May until mid-July 05.
Along with 13 Eye Health Workers from other eye hospitals of the eastern region altogether 56 went through a "Pre-Qualifying Test" and 52 Eye Health Workers passed the final Skill Test held at SCEH.

Various other Trainings:
- 6-months Training for Primary Eye Health Workers at SCEH:
- Completion of Training for 15 candidates by 31.3.2005 (1st batch).
- Training for 4 candidates from 1.4.-30.9.05 (2nd batch) and start of
training for 19 candidates (3rd batch) from 1.10.05.

- 1-day Training on Primary Eye Care, held by 2 SCEH staff in 2 villages for 2
batches of Female Community Health Volunteers (FCHV), altogether 44,
on 27th and 28th April 2005.

- OA Ramanand Bishwakarma: 2-months Certificate Course in Fundus
Fluorescein Angiography and Ultrasonography at Aravind Eye Hospital,
Madurai/South India, May/June 2005.

- Ophthalmic Assistant Supervisor Chandra Narayan Chaudhary: one-week
Management Training in KTM from 22.5.05.

- OA Ram Kumar Jha: 3-days Refresher Training in Low Vision at Himalaya
Eye Hospital in Pokhara from 24.5.05.

- OA Ram Kumar Jha: one-week Functional Assessment Trainers Training
in Low Vision at Sharp Memorial School for the Blind, Dehra Dun from
15.6.05.

- Chief Administrator Bindeshwar Mahato: NNJS Strategic Workshop in
Kathmandu in June 05.

- Prof. Arin Chatterjee from India stayed again in Lahan from 26.6.-28.7.05
and provided a one-month refresher training for ophthalmologists and
ophthalmic assistants.

- Mr. Mahendra Mahato: one-week Orientation at Aravind Eye Hospital,
Madurai end of June.

- OA Satya Narayan Singh: two-months short-term Low Vision Fellowship at
LVP Eye Institute in Hyderabad from 1st July 05.

- One-day Training in School Screening at SCEH to 18 Primary & Secondary
School Teachers from Siraha and Saptari on 5.7.05.

- OAs Ram Sewak Sah and Dipendra Chaudhary: one-week Refresher
Training in Low Vision at Himalaya Eye Hospital in Pokhara from 19th till
25th August 05.

- Dr. Sanjeev Kumar Tiriya: one-week HBP (Hospital Based Programme) on
Paediatric Ophthalmology at Shree Ran-Ambika Shah Eye Hospital
(SRASEH) in Bhairahawa from 26th September 2005.

Conferences, Workshops and Courses:

· 63rd All India Ophthalmological Society (AIOS) Conference, Bhubaneswar/Orissa, 13.-16.1.05: Dr. Anil Kumar Singh: SICS, Fishhook Technique.

· 24.-28.1.05: Dr. A. Hennig: "The Fishhook Technique" at the University Eye Hospitals in Yangon and Mandalay in Myanmar.

· Ophthalmology Congress 2005 of Ophthalmological Society of South Africa (OSSA), Cape Town, 5.-8.3.2005: Dr. A. Hennig: 1. From Sutured to Sutureless Cataract Surgery; 2. Small Incision Cataract Surgery - Instruction Course; 3. The Lahan Experience in Phaco.

· ICO Asia Pacific Academy of Ophthalmology Symposium (APAO), Kuala Lumpur/Malaysia, 27.-31.3.2005: Dr. A. Hennig: How to Efficiently Manage Congenital Cataracts in Developing Countries.

· CBM South Asia Region Office North Workshop in Noida: 20.4.05: Dr. A. Hennig: Phacoemulsification - Lahan Experience.

· Ophthalmological Society of West Bengal (OSWB), Burdwan, 8.5.2005: Guest Faculty Dr. A. Hennig: Update on Cataract Surgery; Dr. Anil Kumar Singh: Modified Fishhook Technique.

· CBM Medical Eye Care Workshop in Nairobi/Kenya, 23.-25.5.05: Dr. A. Hennig: Learning Curve & Outcome of Phaco Surgery at Lahan.

· DOC (Congress of German Ophthalmologists) in Nürnberg/Germany, 23.-26.6.05: Dr. A. Hennig: 1. Vision 2020 on the sample of Lahan, Nepal; 2. Eye Surgery in Developing Countries - Chances and Problems from the Asian point of view; 3. Long-term Assignments in Developing countries.

· Intraocular Implant and Refractive Society Conference (IIRS), held by the National Institute of Ophthalmology, Maharastha Ophthalmic Society and Pune Ophthalmic Society, Pune, 19.-21.8.2005: Dr. Anil Kumar Singh - Live Surgery on two days and Keynote Lecture, Fishhook Technique & Visual Outcome; Dr. Chirag Bhatt: Dropped Nucleus and IOL Management.

· 9th Anniversary Scientific Meeting, BPKLCOS, Kathmandu, 9.9.2005: Dr. Rajan Rana: Learning Phaco - The Lahan Experience; Dr. Chirag Bhatt: Vitreo-Retinal Work at Lahan - Initial Experience.

· Vision 2020 Workshop in Kathmandu, 21.-23.10.05: Dr. A. Hennig: Financial Resource Development, District Level, Nepal.

Staff:
The 125 member staff consists of 10 ophthalmologists (2 VR surgeons, 3 long-term, 5 under 2-year Anterior Segment Fellowship) and 1 Medical Officer, 6 administrative staff, 14 ophthalmic assistants and 7 ophthalmic assistant trainees, 48 eye workers and 39 others (watchmen & security guards, maintenance helpers, gardener, drivers, sweepers, peons etc.).
Two long-term ophthalmologists left SCEH end of September and end of November 2005.

Hospital Management Information System and Data Collection:

Since 2004 the hospital added computers in the Administration, Outpatient Department and Operation Theatre and introduced Networking of 12 computers connected to a Data Server.

Also, a special Hospital Management Information System (HMIS) was designed in-house according to the hospital's requirements and implemented stepwise since 2005. Data on book keeping/accounts, inventory management, billing as well as patient record data including pre-op, post-op and VA findings are now easily available for effective decision-making, quality control as well as for statistical analysis, reporting and research.

Since the HMIS has meanwhile become so important for smooth hospital management, the IT expert Klaus Lehmann from CBM HQ Germany visited Lahan from 25th November till 2nd December 2005 and a new backup server and tape backup system were added to the HMIS system.

Preparations for a Satellite Hospital in Biratnagar:

SCEH has become one of the largest eye treatment centres in the world. However, it has been facing increasing difficulties to get sufficient qualified ophthalmologists required to cope with the constantly growing patient number. According to an organisational assessment study carried out by Michael Schueber/CBM the remoteness and unattractiveness of the town Lahan along with its lack of infrastructure in terms of adequate schooling, transport, general medical facilities, shopping etc. were identified as the main barriers for ophthalmologists and their families to stay long in Lahan. Therefore it was decided to set up a branch of SCEH in Biratnagar, the second largest city in Nepal, 125 km east of Lahan. Biratnagar has a good infrastructure and all the facilities which Lahan is lacking. With this new branch in Biratnagar, to be developed later into an Eastern Regional Eye Centre, it is anticipated that in future, ophthalmologists working in Biratnagar could help to overcome the manpower problems of SCEH.

SCEH already purchased about 5 hectares of land in Biratnagar for possible future construction. In the meantime suitable premises for the new Satellite Hospital in Biratnagar have been identified for rent.

CBM delegated Mr. Schueber for 30 days in March 2005 and again two months from November 2005, especially to move forward with setting up the new Satellite Hospital in Biratnagar.

Project Visitors:
54 visitors came to Lahan mainly to observer the eye work.

Awards:
In September 2005, Dr. A. Hennig received the "Social Service Award" on the occasion of the 26th Social Service Day of the Social Welfare Council of Nepal by Her Royal Highness Crown Princess Himani Rajya Devi Shah.

Book Chapter:
Hennig A, Singh V: Small Incision Cataract Surgery, Book Chapter in Sandeep Saxena: “Ophthalmic Surgery - The Cutting Edge”, Jaypee Medical publishers, New Delhi 2006, 259-71, released during the AAO in Chicago in 2005.

SUMMARY:

The year 2005 was very successful with nearly 60,000 eye surgeries performed, including increasing operations not only on cataract patients, but also on children and patients with vitreo-retinal diseases. This high number indicates the excellent results and affordability of the eye services. Many patients sometimes travel two to three days to Lahan for treatment.

However, along with the growing patient number the amount of qualified ophthalmologists for SCEH did not grow simultaneously.

To perform nearly 60,000 eye operations with only 10 ophthalmologists required excellent management, high motivation, very hard working and a good team spirit.

We hope that the establishment of a branch in Biratnagar will help to overcome the manpower shortage in Lahan and thus lead to long-term sustainability of SCEH.

Acknowledgements:

[Outpatients and Surgery] [Special Services] [Outreach Activities] [Teaching and Training] [Miscellaneous] [Acknowledgements] [Up] [Home]