In a world where providing eye care remains a significant challenge, particularly in war-torn regions, organizations like Sightsavers and Orbis shine as beacons of hope. Sightsavers, operating in Africa and South Asia, employs an adaptive management process to deliver care in dangerous areas, while Orbis addresses the vital need for eye care among refugees.
Saving a patient’s threatened vision is already a challenge under the best of circumstances. But when the stark realities of global politics get involved, this task becomes even more daunting. Providing eye care to the underserved remains one of the greatest obstacles faced by the medical profession to this day. And few places are so critically underserved as those affected by war, including those to which refugees have been forced to flee.
Healthcare providers working in conflict zones were recognized during the Orbis Symposium: Global Ophthalmology in War Zones at the recently concluded European Society of Cataract and Refractive Surgeons Congress (ESCRS 2023). Amid the numerous symposia at this year’s Congress in Vienna that focused on the technical aspects of ophthalmology, the Orbis Symposium took a different turn. This session shifted its focus to the political and economic challenges faced by doctors struggling to bring even basic services to those who are most in need.
Due to the tremendous challenges associated with delivering these services to far-flung and often dangerous locations, these eye care professionals often work as part of non-government organizations (NGOs) and charitable entities. Without these structures, the task of securing financial, logistical and legal support for their incredible work would likely be impossible.
Representatives from two of these important organizations introduced their missions and discussed the numerous obstacles they have to overcome to preserve patients’ vision.
Sightsavers in war-torn Africa
Ms. Sumrana Yasmin introduced the audience to Sightsavers, an international NGO that works in over 30 developing countries in Africa and South Asia to treat and prevent avoidable blindness.
“Our primary focus is on creating a world where no one is blind from avoidable causes, and where people with disabilities can participate equally in society,” said Ms. Yasmin, the deputy technical director for Eye Health and Unaddressed Refractive Errors (URE) of Sightsavers. “Within that sphere, we focus on protecting sight and fighting disease, as well as disability programs where social inclusion of people with disabilities is ensured.”
To address this tall task, Sightsavers employs an adaptive management process that focuses on conducting a landscape assessment of the area where they intend to deliver care. The first step is to identify marginalized communities and analyze their needs in terms of health services and required products. In addition, the organization must evaluate the risks implicit in operating in dangerous areas as well as security options that are available.
Part of this risk analysis involves carefully prioritizing safety, including mitigation plans, as well as evacuation strategies for healthcare staff. These precautions aren’t without valid reason. “In the last eight months,” Ms. Yasmin explained, “I can actually remember three instances where we had to apply these plans to take out our people from these situations. In these cases, the most important factor was having the right resources, including both financial support and competent, secure individuals to deliver these services.”
Amid these concerns for the physical and mental well-being of caregivers, quality of care becomes a real concern as well. Delivering primary care, which these eye care workers have come onsite to provide, as well as managing follow-up care, becomes increasingly challenging due to the inherent danger of working in conflict zones. On top of this, the ongoing threat of resource theft is a further concern, and the cost of delivering eye care in these zones is at least 20% to 25% higher than it is in a usual clinical setting.
However, on the flip side, Ms. Yasmin noted that the opportunities to help people make all these challenges worthwhile. “We have a very strong focus on leaving no one behind,” she said. “Working in these locations helps us reach the most vulnerable population.”
Through their frontline work in these war zones and the strengthening of partnerships with local caregivers, Sightsavers is a true game-changer in the lives of millions of patients whose vision may otherwise have been lost amid the strife of local conflict.
Delivering eye care to refugees with Orbis
While patients within a war zone are likely in the most peril, the challenges for victims of conflict do not instantly get easier once they have fled from the threat of harm.
As a leading NGO dedicated to saving sight worldwide, Orbis International, the host of the symposium, is at the forefront of providing ophthalmic care to refugees.
Dr. Robert Walters, the chairman of Orbis in the Middle East, spoke on the threats faced by refugees who are fleeing conflict.
“Among those displaced people,if you are a refugee, you instantly become poor,” Dr. Walters began “And you experience everything that comes with poverty. These people are flung together, often within walls.”
Dr. Walters introduced the work that Orbis has done in cooperation with the United Nations High Commission for Refugees (UNHCR), providing eye care services among the Rohingya refugees who have fled Myanmar to neighboring Bangladesh.
The Rohingya, like many refugees, faced significant discrimination in the country from which they had fled. Notably, they faced medical discrimination, with most having received little to no primary care before escaping into the dire situation of a refugee camp.
It is in such situations that care is so vital. And though the challenges presented by providing care in a refugee camp are not as violent as in an active conflict zone, they nonetheless present obstacles. Notably, the UNHCR needed to establish roads, water and septic services and provide basic structure before care could be delivered.
The need for care among these neglected refugee populations is enormous. Dr. Walters reported that one in seven Rohingya refugees has sight-threatening cataracts. Not only is this condition devastating, but it is also one of the most treatable. By establishing clinics that service the refugee community, Orbis is able to preserve the vision of individuals whose lives are already faced with overwhelming challenges.
Amid the dangers presented by global conflict, organizations like Sightsavers and Orbis bring hope and sight to patients who are in the greatest peril. Their work is truly visionary and deserving of our highest respect and admiration.
Editor’s Note: The 41st European Society of Cataract and Refractive Surgeons Congress (ESCRS 2023) took place on September 8 to 12, 2023, in Vienna, Austria. Reporting for this story took place during the event.
