Eye Care in Burma and Thailand
Please note: The eye care project has been discontinued by ARK AID; this because Dr. Frank Green now has his eye's fixed upon the Crown: he has gone to meet his Saviour in Oktober of 2018.
Please note: The eye care project has been discontinued by ARK AID; this because Dr. Frank Green now has his eye's fixed upon the Crown: he has gone to meet his Saviour in Oktober of 2018.
More[PDF]... information about the work of the "Eye Team"
More information about the "Eye Team": Mr Frank Green, Prof John Forrester, Dr Philip Ambler, and technician/manager Tom Scott
A request... for aid from the Eye Team
A presentation... at an IRC meeting
More information about the "Eye Team": Mr Frank Green, Prof John Forrester, Dr Philip Ambler, and technician/manager Tom Scott
A request... for aid from the Eye Team
A presentation... at an IRC meeting
_
The Military junta of Burma has been engaged in long running wars with many ethnic minority groups in the country. For example the war against the largest minority group, the Karen, started in 1950, and there is ongoing military action against the Karrenni and the Shan groups.
In 1988 there was an uprising of ethnic Burmese in Rangoon when many were shot dead and many others had to flee to the relative safety of the ethnic controlled areas on the border of Thailand. At this time refugee camps were set up in Thailand on the border with Burma and Dr Cynthia with some helpers fled into the Thai border town
of Mae Sot and started her clinic for Burmese who had fled into Thailand for refuge. In 1995 the Burmese army finally overran the Karen held area on the border of Thailand and at this point the refugee camps began to swell. There are about 150,000 refugees in these camps at present. It is estimated that the Burmese junta spends $8 US per head of population per year on total health care.
The Surgical Eye Team
Frank Green a consultant ophthalmologist from Aberdeen and Phillip Ambler were invited into the Karen held territory in 1990 and were joined more recently by Professor John Forrester, Professor of Ophthalmology at Aberdeen University. Initially the team made 2 visits per year into the Karen held area of Burma. In 1995 after the Burmese overran the Karen territory many people had to flee into refugee camps in Thailand. The team began to provide eye care in these camps and the number of visits has now increased to 4 per year. Funding for this programme comes from our charity “Karenaid” set up for this purpose. Karenaid receives mainly small donations from private individuals. Donations of consumables are also sought from the manufacturing companies.
The Local Eye Team
General medical services in the refugee camps and Mae Tao clinic are organized by various medical NGO’s who train selected refugees as “medics”. In 1995 the International Rescue Committee (IRC) employed an optometrist to set up an eye care service based mainly in the refugee camps, the Local Eye Team. Groups of these medics have been trained by this optometrist and his successors in multiple locations to be especially responsible for eye care. They are known as Eye Medics This training is carried out by running training days in the different locations along the border and producing training manuals. Until one year ago this programme was funded by IRC. Owing to budgetary constraints funding from other sources had to be found but the programme is still administered by IRC
The Border Eye Team
The Surgical Eye Team and the Local Eye Team together make up the Border Eye Team
The Population
The initial population served was the 150,000 refugees in approximately 10 refugee camps located along the 400km border between Thailand and Burma. Some of these camps have been amalgamated over the years but the population remains pretty much constant. Owing to the poor availability of health care in Burma there has been a steady increase in the number of Burmese who cross the border into Thailand and come to Dr Cynthia’s Mae Tao clinic in Mae Sot for treatment. This population is huge as we have evidence of people travelling from several hundred kms inside Burma to this clinic.
Activity
(1) The Local Eye Team
This is led by a trained nurse who has developed an interest in ophthalmics with 2 local helpers. With his team he is responsible for delivering training to the eye medics, visiting and monitoring activity at the eye clinics, facilitating and coordinating the surgical visits. The components of the programme include:
Primary Eye Care Course
This runs regularly at multiple sites along the border and lasts for 5 days. The curriculum has been developed over the years with the appropriate manuals and aims to deliver the basics of ocular anatomy, physiology and pathology with emphasis on history taking, ocular examination and recognition of the common ocular pathologies. Refresher courses are also run throughout the year. At the present time many refugee medics are being relocated to other countries so there is a continued need for training of new medics. Approximately 60 medics receive training each year
Eyeglass Refraction course
This 7 day course follows the Primary Eye Care course and aims to teach the common refractive errors with practical training in dispensing the appropriate glasses. Eyeglasses are dispensed by the medics at the eye clinics. At present about 12,000 - 15,000 glasses are dispensed per year
Eye clinics
Eye clinics have been established at 9 locations in the refugee camps and another 1 at Mae Tao clinic. 4 clinics have been established outside the camps in Thai –Karen villages. The eye medics who have completed the Primary Eye Care and Refractive courses run these clinics on a regular basis, dispensing glasses, treating minor eye problems and identifying patients suitable for surgery.
Preparation for Eye surgery team
The team organises the 4 surgical visits per year. They ensure the appropriate patients are brought for examination by the surgical team before surgery. An operating theatre and sterilising facility with the provision of a power supply is prepared. Camp passes for all the team are procured. Selected Eye medics assist in the surgery Following surgery the vision for is checked for audit purposes
(2) The Surgical Eye Team
The surgical team make 4 visits per year between 2 – 3 weeks each. They operate in 4 locations on the border. 3 of these visits are to refugee camps and the other location is Mae Tao clinic.
Patient selection
Patients are presented to the eye team who have already been selected by the local eye medics. About 80% will have cataract and 10% glaucoma. 10% will have other pathologies not identified by the eye medics but only identified as having poor vision. These patients are examined by the surgeons and listed for surgery if indicated. Owing to the high quality of training these medics have received, the proportion of patients listed for surgery by the surgeons using very conservative indications for cataract extraction is between 70 - 80% Overall 88% of surgery is for Cataract, 7% for Glaucoma as either Trabeculectomy or Peripheral Iridectomy and 5% for other procedures such as pteryergium and lid malpositons.
Surgical Activity
Catraract surgery is performed with a portable operating microscope by the Small Incision Extracapsular method ( SICS ). Biometry is carried out preoperatively and the appropriate IOL is chosen from the lens bank. The volume of surgery has risen steeply over the years and in 2008 890 operations were performed.
Surgical Training
We have now started training one of the senior refugee “Eye Medics” in cataract surgery.
Future plans
Frank Green plans to increase the time spent with the Surgical Eye Team over the next 3 years with a view to becoming full time. Having successfully begun the surgical training of a local eye medic the surgical capacity would be increased and further carefully selected individuals eventually trained in cataract surgery.
The Military junta of Burma has been engaged in long running wars with many ethnic minority groups in the country. For example the war against the largest minority group, the Karen, started in 1950, and there is ongoing military action against the Karrenni and the Shan groups.
In 1988 there was an uprising of ethnic Burmese in Rangoon when many were shot dead and many others had to flee to the relative safety of the ethnic controlled areas on the border of Thailand. At this time refugee camps were set up in Thailand on the border with Burma and Dr Cynthia with some helpers fled into the Thai border town
of Mae Sot and started her clinic for Burmese who had fled into Thailand for refuge. In 1995 the Burmese army finally overran the Karen held area on the border of Thailand and at this point the refugee camps began to swell. There are about 150,000 refugees in these camps at present. It is estimated that the Burmese junta spends $8 US per head of population per year on total health care.
The Surgical Eye Team
Frank Green a consultant ophthalmologist from Aberdeen and Phillip Ambler were invited into the Karen held territory in 1990 and were joined more recently by Professor John Forrester, Professor of Ophthalmology at Aberdeen University. Initially the team made 2 visits per year into the Karen held area of Burma. In 1995 after the Burmese overran the Karen territory many people had to flee into refugee camps in Thailand. The team began to provide eye care in these camps and the number of visits has now increased to 4 per year. Funding for this programme comes from our charity “Karenaid” set up for this purpose. Karenaid receives mainly small donations from private individuals. Donations of consumables are also sought from the manufacturing companies.
The Local Eye Team
General medical services in the refugee camps and Mae Tao clinic are organized by various medical NGO’s who train selected refugees as “medics”. In 1995 the International Rescue Committee (IRC) employed an optometrist to set up an eye care service based mainly in the refugee camps, the Local Eye Team. Groups of these medics have been trained by this optometrist and his successors in multiple locations to be especially responsible for eye care. They are known as Eye Medics This training is carried out by running training days in the different locations along the border and producing training manuals. Until one year ago this programme was funded by IRC. Owing to budgetary constraints funding from other sources had to be found but the programme is still administered by IRC
The Border Eye Team
The Surgical Eye Team and the Local Eye Team together make up the Border Eye Team
The Population
The initial population served was the 150,000 refugees in approximately 10 refugee camps located along the 400km border between Thailand and Burma. Some of these camps have been amalgamated over the years but the population remains pretty much constant. Owing to the poor availability of health care in Burma there has been a steady increase in the number of Burmese who cross the border into Thailand and come to Dr Cynthia’s Mae Tao clinic in Mae Sot for treatment. This population is huge as we have evidence of people travelling from several hundred kms inside Burma to this clinic.
Activity
(1) The Local Eye Team
This is led by a trained nurse who has developed an interest in ophthalmics with 2 local helpers. With his team he is responsible for delivering training to the eye medics, visiting and monitoring activity at the eye clinics, facilitating and coordinating the surgical visits. The components of the programme include:
Primary Eye Care Course
This runs regularly at multiple sites along the border and lasts for 5 days. The curriculum has been developed over the years with the appropriate manuals and aims to deliver the basics of ocular anatomy, physiology and pathology with emphasis on history taking, ocular examination and recognition of the common ocular pathologies. Refresher courses are also run throughout the year. At the present time many refugee medics are being relocated to other countries so there is a continued need for training of new medics. Approximately 60 medics receive training each year
Eyeglass Refraction course
This 7 day course follows the Primary Eye Care course and aims to teach the common refractive errors with practical training in dispensing the appropriate glasses. Eyeglasses are dispensed by the medics at the eye clinics. At present about 12,000 - 15,000 glasses are dispensed per year
Eye clinics
Eye clinics have been established at 9 locations in the refugee camps and another 1 at Mae Tao clinic. 4 clinics have been established outside the camps in Thai –Karen villages. The eye medics who have completed the Primary Eye Care and Refractive courses run these clinics on a regular basis, dispensing glasses, treating minor eye problems and identifying patients suitable for surgery.
Preparation for Eye surgery team
The team organises the 4 surgical visits per year. They ensure the appropriate patients are brought for examination by the surgical team before surgery. An operating theatre and sterilising facility with the provision of a power supply is prepared. Camp passes for all the team are procured. Selected Eye medics assist in the surgery Following surgery the vision for is checked for audit purposes
(2) The Surgical Eye Team
The surgical team make 4 visits per year between 2 – 3 weeks each. They operate in 4 locations on the border. 3 of these visits are to refugee camps and the other location is Mae Tao clinic.
Patient selection
Patients are presented to the eye team who have already been selected by the local eye medics. About 80% will have cataract and 10% glaucoma. 10% will have other pathologies not identified by the eye medics but only identified as having poor vision. These patients are examined by the surgeons and listed for surgery if indicated. Owing to the high quality of training these medics have received, the proportion of patients listed for surgery by the surgeons using very conservative indications for cataract extraction is between 70 - 80% Overall 88% of surgery is for Cataract, 7% for Glaucoma as either Trabeculectomy or Peripheral Iridectomy and 5% for other procedures such as pteryergium and lid malpositons.
Surgical Activity
Catraract surgery is performed with a portable operating microscope by the Small Incision Extracapsular method ( SICS ). Biometry is carried out preoperatively and the appropriate IOL is chosen from the lens bank. The volume of surgery has risen steeply over the years and in 2008 890 operations were performed.
Surgical Training
We have now started training one of the senior refugee “Eye Medics” in cataract surgery.
Future plans
Frank Green plans to increase the time spent with the Surgical Eye Team over the next 3 years with a view to becoming full time. Having successfully begun the surgical training of a local eye medic the surgical capacity would be increased and further carefully selected individuals eventually trained in cataract surgery.