Bringing Cataract Surgery to People 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 results in decreased economic productivity, as the afflicted individual is unable to work and earn wages. In many parts of the 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 known as manual small-incision cataract surgery (MSICS) has been introduced. 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.

In conjunction with the Ministry of Health and Social Protection of Tajikistan and the Tilganga Institute of Ophthalmolgy, we have designed training programs in MSICS for surgeons in Tajikistan. Thus far, four surgeons, including one from the Eastern region of Gorno Badakhshan Autonomous Oblast, have received hands-on MSIC training in Nepal. Collectively, these trainees have provided surgery to more than 4000 individuals. This training has made high quality cataract surgery significantly more affordable by substantially lowering the out of pocket costs to patients and families. We are also involved in closely monitoring surgical outcomes as well as surgical proficiency in the trainee surgeons.

Supporting 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 has worked with Community Health Education Services by Tele-health (CHEST), a Nepali NGO, to support capacity-building for teledermatology with the goal of helping rural villagers receive care for dermatologic ailments. This project involved 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.

Increasing Access to Medical Information for Skin Care Providers

Providing high quality medical care requires accessing the latest medical literature.  That is why PASHA has worked in conjunction with the American Academy of Dermatology to translate and disseminate educational material for skin care providers across Tajikistan.  To build on this project, we are currently working with local dermatologists to develop clinical guidelines that can be adapted to Tajikistan and used for the treatment of common skin conditions.