From the field / Eye health /

Pop-up eye screenings on the doorsteps of marginalised communities

October 2020

Many people sit outside waiting for an eye examination.

In February 2020, Sightsavers’ Kirsty Bridger visited Bangladesh to learn how we organise our eye screening camps.

Pop-up screening camps are at the heart of what Sightsavers does: we take free eye health care directly to the people who need it most.

I was lucky enough to see our work in action and watch our team in Bangladesh set up one of our pop-up screening camps in Rangpur. The camp was specifically set up for the Bihari community, a minority group of people who have experienced discrimination and lacked access to essential services since they fled violence in India in the 1940s to live in Bangladesh (known at the time as East Pakistan).

Here’s how we set up the screening camp in nine steps:

Step 1: Identify who we need to reach and where to hold the camp

A slim walkway through an informal urban settlement

Our team partnered with OBAT Helpers, a local organisation that works closely with the Bihari community. We identified that in Rangpur, the Bihari live in a large informal urban settlement. To ensure as many people as possible felt comfortable attending the screening camp, we set up in the courtyard of the school OBAT runs for local children from the community, just five minutes' walk from their homes.

Step 2: Make sure everyone knows where to go

We worked with volunteers from OBAT to promote the camp with mobile announcements…

Men putting up a sign to welcome people in Rangpur, Bangladesh to a free eye screening camp.

…and we put up welcome banners at the entrance to the school courtyard.

Step 3: Invite everyone to register

At the camps people tended to arrive throughout the day, not just at opening time, so it was essential to make sure the registration desk was clearly visible and easy to find. When our camp opened in the morning, children were in class, but at lunch there was a rush of activity as they were eager to get in on the action and have their sight tested too.

Have plenty of seats ready because it gets busy!

Men sit outside waiting for an eye test.

Step 4: Conduct initial sight tests

After registering, everyone – no matter their age or symptoms – was sent to the first pop-up room to receive a sight test from our ophthalmic assistant, Assaduzzaman Babu. The room was constructed the day before, using bamboo canes and colourful fabric. This made the camp feel inviting and relaxed, which was especially important in reaching people who weren’t used to accessing healthcare in a clinical setting.

Step 5: Send attendees for an eye examination

A doctor shines a torch into a man's eye.

After the initial sight test, every attendee then visited the second room where Dr Md. Azizul Islam examined their eyes. Patients diagnosed with cataracts were directed back to the registration desk to complete a referral form for a free cataract operation.

Step 6: Refer patients to the refractionist

If the patient was identified as needing glasses, or needed an alteration to their current prescription, they moved on to the third room. There, the refractionist Md. Rezaul Karim could determine how each patient’s vision could best be improved, and prescribe glasses or eye drops.

Step 7: Record any referrals needed

Two women sit on a registration desk with a queue of people waiting.

Patients who needed a cataract operation or glasses were taken back to the registration desk so their referral could be recorded. This process was carefully managed with the local partner hospital to ensure patients would receive pre-operative health checks for things like blood pressure and blood sugar. People who were prescribed glasses had them delivered to their homes within a couple of days by local volunteers from OBAT (who are often members of the Bihari community themselves).

Step 8: Provide transport to the hospital on the same, or next day

Free transport was arranged to take people to the hospital, so they could have any surgery as quickly as possible.

It was essential for our pop-up camp to be held within walking distance of people’s homes. Many people who are part of marginalised communities don’t have access to transport, either because it’s too expensive or because they fear using public transport, especially while their vision is limited.

Step 9: Evaluate who we reached

The number of people with sight loss in low and middle -income countries is four times higher than in high income countries. The proportion of vision impairment and blindness tends to be greater in rural areas, as well as for older people, women, people with disabilities, ethnic minorities and indigenous populations. And although more than half of people who are blind are women, they are also half as likely to seek treatment, so it was essential that we accurately recorded who attended our camp and who received treatment. This will help make sure future screening camps, and ultimately all of our work, is inclusive for everyone.

Of the 321 adults and children who attended the one-day camp…

75

were given eye drops

57

needed cataract operations

52

had their glasses checked

29

received pairs of glasses

On the drive back to our accommodation I reflected on the day’s activities and thought about the people I’d met, like Hasina, who attended the camp with her son-in-law. She told us her family had experienced discrimination in the past –she was sick with worry that her sight problems meant she wouldn’t be able to see people coming to demolish her home again.

Without this safe, local and free eye camp, Hasina, along with many others, might have sought support through the standard healthcare system, and would not have been able to afford the cataract operations she needed. She would have continued to live with a condition that is entirely treatable.

For years, I’ve known that our eye camps are extremely effective. But it wasn’t until I experienced the welcoming atmosphere, and the thoughtfulness of our staff and local partners on the ground, that I really appreciated why. Our ‘effectiveness’ in terms of reaching large numbers of people is only a reality because of our commitment to adapt our projects and ensure they are tailored to the communities we aim to reach.

During my visit to Bangladesh, I also met with Professor Enayet Hussain, one of the country’s most senior ophthalmologists and director-general of medical education in the Ministry of Health. “My responsibility is to improve the health of our country,” he told me, “and Sightsavers has helped the government to fulfil their mandate.

“They have helped us to mobilise communities,” he continued. “It is an excellent contribution as the government does not have community outreach programmes. People in rural communities definitely trust Sightsavers and as government, we have integrated our existing health systems into Sightsavers programmes.”

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