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The Trust supported LVPEI through a Rs. 1.7 million grant, spread over a three year period, towards fellowship support that would enable 108 eye-care professionals to undergo training on low vision related issues. Two types of training programmes were designed, the first of which were three day orientation programmes aimed to raise awareness levels on diagnosis, care, treatment and rehabilitation of low vision patients. Nine such programmes over the three year period reached out to 223 eye-care professionals. The second programme was a three month training programme, which created a pool of eye-care professionals trained on low vision, with the ability to set-up low vision services in eye-care centers and conduct clinical examinations and prescribe appropriate corrective measures. A total of ten such programmes over the three year period reached out to 20 professionals.
The Trust supported MRF through a three year grant of Rs. 6.6 million towards the Sir Ratan Tata Trust Community Ophthalmology Fellowship Programme, which enabled 116 ophthalmologists to undergo training for implementing a community outreach programme, besides conducting 3,000 sight restoring cataract surgeries on poor patients. The second phase, starting April 2003, would reach out to an additional 180 ophthalmologists, besides conduct over 4,500 cataract surgeries over the next three years.
With a view to assess the effectiveness of the fellowship programmes and design their respective second phases, the Trust encouraged both MRF and LVPEI to secure systematic feedback from the fellows. Both organisations undertook surveys through a comprehensive questionnaire to alumni of the programmes. While lessons from these are drawn into design of the respective programmes, the survey results, based on replies received from respondents, reveal some interesting trends for similar programmes.
Profile of the fellows:
Analysis of the 62 responses received from the LVPEI survey revealed that Fellows who undertook the Low Vision Awareness Programme and the Short Term Fellowship at LVPEI consisted mainly of optometrists (66%) and ophthalmologists (26%), whilst eight per cent constituted of rehabilitation professionals. All the Fellows that undertook the Sir Ratan Tata Trust Community Ophthalmology Fellowship Programme at MRF possessed degrees in ophthalmology, with a few also having FRCS and MD qualifications.
Work Experience:
The average working experience of respondent Fellows from LVPEI was three years, going up to a maximum of 23 years. Nearly 55% of these were affiliated with voluntary organisations, with the rest being associated with government organisations and doing independent practice. Their primary area of activity included: (a) general ophthalmic examination; (b) low vision care; (c) training of personnel; and (d) centre and community based rehabilitation. The fellows from MRF practiced at private hospitals, charitable hospitals, academic institutions and government hospitals. Some of them also practiced at Sankara Nethralaya and LVPEI.
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On completion of their fellowship programme at LVPEI, over 56% of the respondents continued practice with volunteer / charitable set-ups. These professionals saw an average of 31 low vision patients and 46 children in a month, while prescribing an average of 16 low vision devices. Nearly a third of them were involved in training of personnel. The constraints in providing low vision care, as cited by them, include: (a) lack of motivation; (b) pre-occupation in providing general ophthalmology services; (c) non-availability of low vision devices; and (d) lack of awareness.
Analysis of the 41 responses received from the MRF survey revealed that nearly 50% of the respondents were practicing at charitable hospitals and academic institutions. All the respondents performed cataract surgeries. Availability of equipment, in this case, the phaco machines, restricted their ability to perform the skills learnt, with only 68% practicing phaco techniques. On an average, the fellows performed 6-10 Phaco surgeries per month after the fellowship programme. Interestingly, 51% of respondents had also commenced teaching cataract microsurgery, thus spreading the expertise acquired during the fellowship programme to a large number of emerging ophthalmologists all over the country.
Views on the Fellowship Programme:
A significant proportion of the fellows from LVPEI felt that the course content enabled them provide quality treatment to low vision patients. They were unanimous in their verdict that the knowledge gained also gave them the confidence to overcome some of the barriers they faced earlier in the delivery of low vision care.
The fellowship programme at Sankara Nethralaya was unanimously rated as the best programme of its kind in the country by all respondents, amongst the various fellowship programmes that they had attended, with 75% of the respondents declaring the programme to be extremely effective in leading to considerable improvement in their skill levels in Phaco surgery.
Suggestions for improvement in programmes:
LVPEI alumni emphasized the need to overcome constraints including: (a) sensitizing NGOs on low vision; (b) effective low vision awareness for the community through print, electronic media, etc.; (c) professional education and conducting workshops for eye care professionals all over India; and (d) public health programmes incorporating low vision screening.
MRF participants felt that the current programme was essentially a basic foundation course in Phaco and an advanced programme was required after a period of time. A few areas for improvement were identified, such as, increase in the number of surgeries during the fellowship period and opportunities to handle more complex cases.
Some comments about the fellowship programmes …
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…"This programme has changed my career drastically from an ordinary general ophthalmologist to an established Phaco surgeon…"
…"As it stands, the fellowship programme is an extremely well organized and well executed programme, the highlight being the constant detailed supervision by the consultants, which is lacking in other Phaco training programmes…"
…"I am now more confident in attending low vision patients after attending the Low Vision Awareness Programme (LAP) Conference…"
…"The programme was excellent in many ways. Earlier, I would prescribe low vision aids with some apprehension, uncertain about its acceptance. Now I recommend the appropriate device, besides rehabilitating the patient in a more professional manner…"