“Nayantara : An integrated mobile service for treatment of diabetic

retinopathy in semi urban and rural India

Dr. Mohita SharmaChief Ophthalmologist

Tirupati Eye CentreNoida, India

India : home of largest number of diabetics in the world• WHO estimation of diabetes 135 million in 1995 to 300 million in 2025• Indian estimation 18 million in 1995 to 54 million in 2025 (195 %)• INDIA- largest diabetic population- 50.8 million (followed by China 43.2 million)

Indian Challenge

• 70% people live in rural areas• 70 % ophthalmologists live in urban areas• Majority of diabetics are undiagnosed• UNDIAGNOSED CASES 2/3 in urban ¾ in rural areas

Uttar PradeshNo population based surveys on diabetic retinopathy

• Most populous state

• 190 million population

• 16.4 % of whole population

Barriers for treatment of DR

FFA LASER

Unable to perform/interpret 45 % 60 %

Equipment costly 71.25 % 71.25 %

Patients cannot afford 35 % 35 %

Number of patients doesn’t justify investment

70 % 70 %

Instruments is/are unnecessary

12.5 % 12.5 %

Solutions

• Share equipment • A mobile van• Sound economic model aimed at Sustainable

Charity• Economic incentive for local doctor• Offer free service for the poor

Project: Tirupati Eye Centre DR Mobile Unit•Diagnosis and treatment of DR and complications • 5 districts of Western UP• Mobile unit• Pre decided route map• Local ophthal, GPs access to equipments

Mobile unit details • Heat- AC- temp regulation• Dust- air ionizer- dust free• Electric power supply-

generator, UPS• Voltage fluctuation-

stabilizers

Team in the mobile unit

• Trained retina consultant• Optometrist• Paramedical worker• Driver

Work at mobile unit

Free of cost treatment to poor patients and minimal charges to

those who can pay

Refuse treatment to none for want of money

Sound economic model• Minimal charges for those who can pay• Earnings are shared between the local Doctor

(ophthalmologist/ physician) and the Project• Physician/Ophthalmologist – Timely eye

treatment EARN WHILE THEY LEARN/TREAT • Project income– SELF SUSTAINABLE

Target population

•231,402 diabetics •Diabetic retinopathy 67,106 in this population•Treatment would prevent 1735 people from becoming blind.

Training

• Ophthalmologist trained in retina on board• Each participating ophthalmologist

individually trained on the stopovers• Lot of enthusiasm to learn

CMEs/ training sessions with lectures

Model eye laser session

• Doctors use the laser machine to obtain burns in the model eye

• Concept of spot size, power, duration, interval and its effect in model eye are understood

Doctors Training

AMC CME Date: 09th Oct 2010- Physicians

Training session : Local health workers

Training sessions- Booklets

• Hindi and English• For Doctors as well as lay public

Community participation- religious organizations and clubs

Noida Diabetes Forum

Lions Club

Sai Temple

Diabetes Camp at Haldwani

What we have achievedAchieved

Trained ophthalmologists 98

Trained GPs 142

Trained healthcare workers 102

DR screening 14565

FFAs 3830

Lasers 4689

Perimetries 3607

Lessons learnt

• Training most important aspect- retained interest of ophthalmologists, GPs also need a continuous reinforcement by training in steps:

1. CMEs2. Practical training- screening for DR changes on retina

• Regular training sessions-1 time training not sufficient, assessment of the adequacy of training and capacity building

Training of “already trained” ophthalmologists

Lessons learnt

• Semi urban areas- patients- paying capacity not very low. Project has reached self sustainability in 50% of its expenses

• Semi urban areas- ophthalmologists- low cost lasers and FFAs

Challenges ahead

• Manage the running costs by income generated on the van

• Replace van and equipment periodically• Add on new districts to the area of coverage• Replicate the design in other parts of India

and the world

Conclusion

• Empowering local community/professionals to access quality care, skills and knowledge

• Taking superspeciality care for treatment of diabetic retinopathy to the unreached

“ If you want to feed a man for one day, serve him fish. If you want to feed him for life, teach him

fishing”

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