The view from Peshawar
Soft-spoken and friendly, Dr Mohammed Naeem Khan and Dr Mohammed Younas Khan have come from Peshawar, Pakistan, to train in Pediatric Ophthalmology at LVPEI. The two Pathans are from the Pakistan Institute of Community Ophthalmology (PICO), a government institute in Hayatabad Medical Complex of Peshawar in North West Frontier Province (NWFP).
PICO had its beginnings in a small room in 1989, following a World Health Organization survey on the prevalence of eye disease. The survey showed that cataract accounted for 71 percent of blindness in Pakistan - this was both preventable and treatable. By 1997 PICO had grown into the full-fledged ophthalmology institute it is today. Dr Younas Khan has been with PICO since its inception, while Dr Naeem Khan joined in 1993.
The institute has two wings — clinical and community eye care. The eye hospital handles 400 - 500 surgeries a month, 60 per cent of them are for cataract. Majority of the ophthalmologists are trained in comprehensive ophthalmology; this is slowly changing as doctors opt for training in subspecialties. With growing awareness of subspecialties of the eye PICO now has clinics in cornea, retina, ocular surfaces, oculoplasty, and pediatric ophthalmology. From just one or two, the number of patients seen in these specialty clinics has risen to about 40 per day.
Dr Younas explains that eye centres in the Pakistan districts are well appointed, but they lack specialty treatment. PICO is the only tertiary care hospital in NWFP, pioneering subspecialty care. Its catchment area includes part of Punjab, the Federally Administered Tribal Area (FATA) and the whole province of NWFP. Almost 20 per cent patients come from Afghanistan, as the borders are open. Community screening programs are conducted regularly, with the involvement of the district ophthalmologist. Specialty cases are referred to tertiary centres. Studies show that the prevalence of cataract is now down to 60 per cent.
The hospital provides free consultation and surgery; patients are required to buy part of the consumables for surgery, including foldable IOLs etc. This system dramatically reduces the costs of surgery for poor patients. The doctors are permitted private practice, where the waiting time is much reduced. There is an area in downtown Peshawar where these private poly-clinics are located. This place comes alive in the evenings when doctors return from government hospitals to see patients who can afford to pay for more personalized treatment. Cataract surgeries are performed at day care centres. Though corneal transplants are performed occasionally, there is no eye bank and no facilities for storage of corneal tissues.
Dr Naeem's wife Nasreen Laiq is an anesthetist and had come earlier this year for short-term training to LVPEI. The couple have five children. Dr Younas Khan jokes he is a step behind, with four children. They are soaking up the atmosphere in India, especially the fabulous weather, which is far better than the extreme heat and cold of Peshawar. They say walking around in Hyderabad feels pretty similar to walking about in Pakistan — the people are warm and friendly. Both of them agreed that they had a lot to learn at LVPEI. They hope that this process of learning will continue and their colleagues at PICO will also come over for their specialisation in the future.