The country has one of the fastest-growing economies in the world, and it’s a fair bet that something you are wearing was stitched there. The rice and prawns we eat? Quite possibly from Bangladesh. Millions of Bangladeshis working overseas also send money home, helping to drive the economy.
Yet despite progress, poverty is still widespread here, especially in more remote, rural areas – home to about 80% of the country’s population of 160 million.
Sightsavers started working in Bangladesh in 1973, shortly after the country’s independence. Many of the eye hospitals here were established through Sightsavers-led initiatives, and it’s thanks to our work that district-level government hospitals started to offer eye care services, especially cataract surgery.
Eye care in Bangladesh is provided by the government, non-governmental organisations and private companies, and there are about 230 NGO and private hospitals providing eye care services. The government runs 64 hospitals, with half of them providing cataract surgery.
During our visit we left the traffic of the capital, Dhaka, behind and headed north, driving through green rice paddies. Even outside urban areas, Bangladesh felt busy. We were on our way to Mymensingh to visit the eye hospital there, which Sightsavers has supported since it opened in 1982.
We arrived at a much larger hospital than expected, where we were warmly welcomed by Mr Parag – he’s the son of Dr Zaman, the ophthalmologist who founded the hospital. It offers eye care to 17 million people in northern Bangladesh, who are cared for by 127 friendly members of staff, including eight ophthalmologists and five resident doctors. Mr Parag told us that between 400 and 700 people a day pass through the hospital, every day of the year.
Staff here are acutely aware of waiting times, telling us that if patients are not registered promptly, they are less likely to stay or return. They have therefore devised a traffic light system to let all staff know when more help is needed at the registration centre.
Once registered, all patients are screened for a range of eye conditions, such as cataracts, glaucoma, diabetes or the need for reading glasses. There are a series of rooms, for low vision, sight tests, refraction, pre-surgery health checks, patient counselling and more, including a separate paediatric centre upstairs where children can play on swings and slides.
The aim is for all patients to receive treatment on the day they register. This applies to cataract patients too – they register in the morning and, provided their health is stable, they can have surgery later that day.
Asma, from Sightsavers’ Bangladesh country office, explained that almost all the partner hospitals Sightsavers works with have a sustainable model: this hospital is well-known for its high-quality care and some patients are willing to pay for their treatment. Any profit generated means people who cannot pay for eye care can be offered free services, bridging the gap between those who can pay for their treatment and those who can’t. Sightsavers is also helping to introduce a subsidy system, meaning people who can pay for part of their treatment also don’t miss out.
We are also helping the hospital to ensure the services it offers are as inclusive as possible by reaching the most marginalised people who might not otherwise come forward to get treatment. This includes people with disabilities, ethnic minority groups, women, elderly people, and people from the very poorest communities.
One of the ways to do this is through electronic record keeping. Information about patients, for example where they’re from, is gathered and can then be analysed. It means the hospital can gauge whether it is reaching marginalised people – and act accordingly if it’s not. It’s certainly a step up from paper files, which are now held in an archive.
Much of the work we have done here involves training, paperwork and behind-the-scenes admin, but it is vital: none of the frontline activities could happen without all of this effort.
As part of its eye care remit, the hospital carries out up to 35 cataract operations each day to restore people’s sight, and we were given the chance to watch the surgery in action.
Each theatre was manned by an ophthalmologist, two nurses and other staff. They follow a model developed in India, where more than one patient is taken into the operating theatre at a time. This ensures the staff’s time and the equipment is used efficiently.
One by one, the patients were brought in. It was amazing how calm they were as they were given their local anaesthetic. While eye surgeon Dr Salam operated on the first patient, another was helped onto the operating table on the other side of the theatre.
As soon as Dr Salam finished the first operation, he changed his gloves and scooted across the theatre to start on the next, leaving a nurse and other staff to bandage the first patient’s eye so they could walk out of theatre. The operating table was then cleared and a new trolley of sterile instruments brought in.