Enhancing Eye Care in Tajikistan

Building Capacity for High Quality, Low Cost Cataract Surgical Services in Tajikistan

According the World Health Organization, nearly 39 million people around the world are blind and another 285 million suffer from some form of visual impairment. Ninety percent of blind and visually impaired individuals live in low-income settings. It is estimated that 80% of blindness and visual impairment is treatable with surgical or medical interventions. The leading cause of blindness worldwide is cataract. Cataract is an opacification of the lens, which occurs with age and leads to significant morbidity. Cataract results in decreased economic productivity, as the afflicted individual is unable to work and earn wages. In the developing world, where families live as cohesive units, the presence of cataract in a family member often places a burden on the entire family. Children frequently miss school and adults leave work to take care of a visually impaired family member with cataract.

Cataract surgery is a highly effective medical intervention, yet more advanced surgical procedures require equipment that can be too costly to purchase and maintain. In the last decade, however, a highly advanced and cutting edge method of cataract extraction has been introduced in the Indian sub-continent, known as manual small-incision cataract surgery (MSICS). This procedure does not require expensive machinery, can be performed at a fraction of the cost of other surgical models, takes less time to perform, and is easier to master. India and Nepal have been highly successful in reducing the burden of cataract blindness using MSICS techniques.

PASHA is working in conjunction with the Ministry of Health in the Republic of Tajikistan to train local ophthalmologists and other medical professionals in MSICS. Our team has introduced a cataract surgery training program through which 2 local surgeons have received extensive training in MSICS and have now begun to train colleagues. Training has been conducted in several phases both in Tajikistan and in Nepal in collaboration with the Tilganga Institute of Ophthalmology and the Shree Janaki Eye Hospital. Thus far, nearly 200 low-income patients have received surgery using this high quality affordable technique. We are also involved in closely monitoring surgical outcomes as well as surgical proficiency in the trainee surgeons. We hope to expand this project to provide additional training for MSICS and help further equip local public facilities for cataract surgery.

Our work has also focused on providing equipment for more accurate diagnosis and for better surgical care for patients. For example, with the help of SEE International, we have delivered medications and instruments for over 500 surgeries since 2013.

Introducing Vitreoretinal Surgery in Tajikistan

With the epidemiological transition from communicable to non-communicable diseases, the prevalence of diabetes and other age-related eye conditions affecting the retina are on the rise in developing countries. Yet, access to vitreoretinal surgery is limited in Tajikistan especially in the private sector. PASHA is working to change that through an ongoing project to bring vitrectomy equipment and supplies to the public eye care facilities in Dushanbe, Tajikistan. We are also in the planning phases of a training program for local ophthalmologists, nursing staff, and surgical assistants in the provision of vitreoretinal surgery. This project is being conducted in conjunction with the input of our expert ophthalmic team in the United States. We also work closely with the Tilganga Institute of Ophthalmology in Kathmandu, Nepal to provide training in Tajikistan.

Establishing Teledermatology Programs in Nepal

Although skin diseases do not commonly lead to death, if untreated they can cause difficulty working, require frequent medical attention, and result in disfigurement and social isolation. In Nepal, access to dermatologists is limited especially in rural villages.

PASHA is working with Community Health Education Services by Tele-health (CHEST), a Nepali NGO to build capacity for teledermatology with the goal of helping rural villagers receive care for dermatologic ailments. This project involves developing the facilities and integrating the necessary technology so that rural patients can receive dermatology services via live video conference with medical professionals in the capital city of Kathmandu. Currently, the pilot village of Gerkhutaar in the Nuwokot district has been equipped with computer access and intranet connection, and which are both being housed by a local community facility to which patients can come and be connected with a physician once a week. PASHA has supported CHEST in re-establishing the infrastructure for teledermatology and other telehealth services in this village after the devastating earthquake in April of 2015. Part of this effort has focused on rebuilding the destroyed heath facilities in the village where patients received medical care.

This program also bolsters community engagement, as the video streaming facilities will be run and organized by local Nepali volunteers. Thus, there is no need for a medical professional or healthcare provider to serve as the middleman in the rural village, because community volunteers can be trained to use the technology and create schedules to organize patient visits. Plans for the near future include optimizing the technology and infrastructure of the facilities at the pilot village and eventually scaling the project to be expanded to villages in other districts in Nepal.

Introducing Evidence-Based Dermatology in Tajikistan

We are currently working with expert dermatologists in Tajikistan to improve access to the latest literature and dermatology guidelines for the treatment of common diseases. This project involves working with our dermatologic colleagues and other experts, translating material into Russian, which is the medical language of Tajikistan, and reviewing this material with local colleagues.