Stepping up to meet visual needs of refugees in Bangladesh

At top, physicians register and check patients in need of ophthalmic care. Center above, patients after treatment. (All images courtesy of Geoff Oliver Bugbee/Orbis International)

This article was reviewed by Danny Haddad, MD.

The sudden influx of refugees into southeast Bangladesh from Myanmar in 2017 was instrumental in creating a settlement of Rohingya, members of a Muslim minority sect, that is larger than some major international populations and their surroundings, and with all the inherent difficulties.

In 2018, the Qatar Fund for Development reached out to Orbis International based on its recognition of the mounting need for eye care in this settlement, which is the largest such in the world. Orbis is an international organization with the mission of preventing and treating avoidable blindness.

Children enjoy the visits from the physicians, who bring treats.

The need for eye care
Upon that request for a helping hand, according to Danny Haddad, MD, Orbis began assessing the timing of the introduction of eye care to the camp based on the living status of the refugees regarding their safety, hygiene, and the basic needs being met first.

“Based on discussions with the World Health Organization (WHO), we saw that this was the right time to start building the resilience of this population, which appeared to be going to remain static for the foreseeable future,” Haddad said. “Ascertaining that the non-communicable diseases were addressed as well was an important issue.”

The organization’s assessment of the camp’s status is one of the largest published datasets on refugee eye health, and it underscored the high degree of eye disease among the members of this displaced population.

Related: Visual impairment high among Rohingya refugees

The study, which indicated the urgent need for eye care among the refugees, was published in PLOS Medicine in March 2020 (https://doi.org/10.1371/journal.pmed.1003096).

A noteworthy aspect of the eye-care program was that the care that was extended was not limited to the refugee population but also included the host population. This decision took into consideration the huge resource drain from the host population that accompanied bolstering of the refugee camps, Haddad noted.

“It was important that their health care needs also were addressed,” he said.

A young boy comes to the clinic for treatment of an eye issue that could threaten his sight.

A major observation of Orbis’ assessment was that cataract-related blindness developed at a much earlier age in the refugee population than in other scenarios.

“This likely reflected the poor living conditions in combination with ultraviolet light exposure, malnutrition, and episodes of severe diarrhea, under which these patients were living,” he said. “Many of these patients who were blinded by cataracts were in their early 40s, about 10 years earlier than in other low-income countries. This was shocking to me.”

The impact of cataract-related blindness was profound when considering the obstacles encountered by the refugees as they fled Myanmar, that is, the need to cross rivers to safety and the difficulty of navigating life in a camp with the prospect of monsoon season approaching with the resultant mud slides and flooded roadways.

“Being able to see again after surgery and establish social connections was incredible for these patients,” Haddad commented.

Related: Surgeon brings cataract care to underserved patients in the Caribbean

Orbis has set up a vision center in one camp that also serves surrounding camps. Vision screening takes place in this center and patients with refractive errors are provided with glasses free of charge. When surgery is needed, patients are transported to a partner hospital, the Cox’s Bazar Baitush Sharaf Hospital.

Children undergo vision screening at the schools in the camp and the host schools for strabismus, congenital cataract, and refractive error. Children who need surgery are transported outside of the camp to a larger hospital where general anesthesia can be induced.

Thus far, about 68,000 people have undergone screening; most visual loss has been the result of refractive errors and cataracts.

Haddad reported that the prevalence of operable cataracts was 3- to 6-fold higher among working-age Rohingya (age range, 18-59 years) than in the host population.

He noted that a random sampling of the Rohingya who had cataracts removed showed excellent surgical outcomes when benchmarked against a large online database of other global users.

Related: Improving outcomes of cataract surgery

The streets are busy in the refugee settlement of Rohingya.

Effect of the pandemic
The COVID-19 pandemic is having a huge impact on this settlement. A big fear is that the virus will run rampant in a living situation such as this. In light of this, some projects currently have been suspended temporarily.

“Great precautions have been put in place by the government of Bangladesh, WHO, and the United Nations High Commissioner for Refugees to protect the camps from outbreaks. In this event, the focus is on providing emergency care. We are working on a lower scale than previously to provide our partners with the opportunity to deal with the pandemic,” Haddad explained.

The global emergency need for personal protective equipment, masks, swabs, and test kits also extends to Bangladesh. While social distancing is difficult, attempts to control exposure include limiting the number of people who can enter the camps.

The orbis.org website provides additional information about the organization, which includes Cybersight, a telemedicine platform, the Flying Eye Hospital, and opportunities for donation.

Read more by Lynda Charters

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Danny Haddad, MD
e:danny.haddad@orbis.org
Dr. Haddad has no financial interest in this subject matter. Dr Haddad is chief of programs, Orbis International, New York.