Post on 04-Jan-2016
description
“Nayantara : An integrated mobile service for treatment of diabetic
retinopathy in semi urban and rural India
Dr. Mohita SharmaChief Ophthalmologist
Tirupati Eye CentreNoida, India
India : home of largest number of diabetics in the world• WHO estimation of diabetes 135 million in 1995 to 300 million in 2025• Indian estimation 18 million in 1995 to 54 million in 2025 (195 %)• INDIA- largest diabetic population- 50.8 million (followed by China 43.2 million)
Indian Challenge
• 70% people live in rural areas• 70 % ophthalmologists live in urban areas• Majority of diabetics are undiagnosed• UNDIAGNOSED CASES 2/3 in urban ¾ in rural areas
Uttar PradeshNo population based surveys on diabetic retinopathy
• Most populous state
• 190 million population
• 16.4 % of whole population
Barriers for treatment of DR
FFA LASER
Unable to perform/interpret 45 % 60 %
Equipment costly 71.25 % 71.25 %
Patients cannot afford 35 % 35 %
Number of patients doesn’t justify investment
70 % 70 %
Instruments is/are unnecessary
12.5 % 12.5 %
Solutions
• Share equipment • A mobile van• Sound economic model aimed at Sustainable
Charity• Economic incentive for local doctor• Offer free service for the poor
Project: Tirupati Eye Centre DR Mobile Unit•Diagnosis and treatment of DR and complications • 5 districts of Western UP• Mobile unit• Pre decided route map• Local ophthal, GPs access to equipments
Mobile unit details • Heat- AC- temp regulation• Dust- air ionizer- dust free• Electric power supply-
generator, UPS• Voltage fluctuation-
stabilizers
Team in the mobile unit
• Trained retina consultant• Optometrist• Paramedical worker• Driver
Work at mobile unit
Free of cost treatment to poor patients and minimal charges to
those who can pay
Refuse treatment to none for want of money
Sound economic model• Minimal charges for those who can pay• Earnings are shared between the local Doctor
(ophthalmologist/ physician) and the Project• Physician/Ophthalmologist – Timely eye
treatment EARN WHILE THEY LEARN/TREAT • Project income– SELF SUSTAINABLE
Target population
•231,402 diabetics •Diabetic retinopathy 67,106 in this population•Treatment would prevent 1735 people from becoming blind.
Training
• Ophthalmologist trained in retina on board• Each participating ophthalmologist
individually trained on the stopovers• Lot of enthusiasm to learn
CMEs/ training sessions with lectures
Model eye laser session
• Doctors use the laser machine to obtain burns in the model eye
• Concept of spot size, power, duration, interval and its effect in model eye are understood
Doctors Training
AMC CME Date: 09th Oct 2010- Physicians
Training session : Local health workers
Training sessions- Booklets
• Hindi and English• For Doctors as well as lay public
Community participation- religious organizations and clubs
Noida Diabetes Forum
Lions Club
Sai Temple
Diabetes Camp at Haldwani
What we have achievedAchieved
Trained ophthalmologists 98
Trained GPs 142
Trained healthcare workers 102
DR screening 14565
FFAs 3830
Lasers 4689
Perimetries 3607
Lessons learnt
• Training most important aspect- retained interest of ophthalmologists, GPs also need a continuous reinforcement by training in steps:
1. CMEs2. Practical training- screening for DR changes on retina
• Regular training sessions-1 time training not sufficient, assessment of the adequacy of training and capacity building
Training of “already trained” ophthalmologists
Lessons learnt
• Semi urban areas- patients- paying capacity not very low. Project has reached self sustainability in 50% of its expenses
• Semi urban areas- ophthalmologists- low cost lasers and FFAs
Challenges ahead
• Manage the running costs by income generated on the van
• Replace van and equipment periodically• Add on new districts to the area of coverage• Replicate the design in other parts of India
and the world
Conclusion
• Empowering local community/professionals to access quality care, skills and knowledge
• Taking superspeciality care for treatment of diabetic retinopathy to the unreached
“ If you want to feed a man for one day, serve him fish. If you want to feed him for life, teach him
fishing”
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