Impact of COVID-19 on vision work

A health worker demonstrates how to use protective glasses when handling suspected coronavirus carriers in Guatemala City. Photo by: REUTERS / Luis Echeverria

GLASGOW, Scotland Vision programs around the world were largely suspended due to blockages, movement restrictions and concerns for the safety of personnel during the COVID-19 crisis. Outreach activities such as eye screenings and elective surgeries have been suspended, and providers expect more demand for these services when programming resumes normally.

The current situation is likely to have an extremely negative impact on eye care and quality of care in general, said Dr. James Clarke, ophthalmologist and medical director of the Ghanas Crystal Eye Clinic, who works in partnership with Unite for Sight in an email to Devex.

Eye care workers look to COVID-19 response

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Those living in remote locations, where services are unavailable and therefore heavily dependent on local services, will be most affected, wrote Clarke. He is also concerned for patients with eye conditions such as glaucoma which, if left untreated, can lead to irreversible damage, he continued. Ensuring staff can work safely and have access to the necessary equipment is an additional challenge for vision organizations at the moment.

But the ongoing emergency may also offer opportunities for eye health experts to provide support and integrate awareness of COVID-19 into their future work. Devex discovers how vision programs are affected by the current pandemic.

Emergency services only

With elective surgeries and community outreach activities pending, many organizations are primarily working on the provision of emergency procedures. Since medical staff are exempt from foreclosure, the Clarkes Clinic has also remained open for limited services, such as eye pressure checks, postoperative care, and medication distribution. However, it is difficult for people to leave the house and go to the clinic, he said, many post-operative patients seek advice from local volunteers or telephone consultations.

Likewise, the charity Sightsavers has suspended all outreach activities and elective surgeries, which primarily treat cataracts. The goal is to reduce the risk of exposure for patients and healthcare workers, said Imran Khan, the organization’s global technical manager. We are still able to deal with and operate in emergency situations where there is a threat to vision, he added.

VisionSpring, an organization based in India that provides eye tests and distributes glasses, also had to suspend most of its work. According to Anshu Taneja, VisionSprings’ national director for India, the organization is working with the government of certain states to distribute glasses that have already been ordered and are awaiting shipment. And, like other organizations in this space, it is looking for ways to contribute to emergency response efforts through logistical support and hygiene knowledge.

Opportunities to share expertise

The nationwide lockdown interrupted VisionSprings’ work almost overnight, so the organization had to think about how it could move forward and be most useful to society during this time. period, said Taneja. We had the network, we had the strength of the supply chain, we had the field strength that could reach the most remote parts of the country, he said, so it made sense to turn to support emergency.

We felt that our core strengths and skills that, for the foreseeable future, could not be used for eye care and eye screening could be used for work on the COVID response, he said.

More time will be needed for coronavirus health education, personal hygiene and protective measures in local dialects in addition to routine eye health education.

Dr. James Clarke, Medical Director, Crystal Eye Clinic

Focusing on India, Bangladesh and five countries in sub-Saharan Africa, the organization is currently seeking to procure personal protective equipment, or PPE, for health workers and masks for wider distribution. . He also sets up handwashing stations and provides community education on the pandemic. The team of 250 people quickly learned about the training and guidelines of the World Health Organization COVID-19. Other training focused on purchasing, Taneja said, and a survey of more than 100 hospitals identified their immediate needs.

Meanwhile, Sightsavers leverages its expertise in community education to highlight the importance of hygiene. Part of the work carried out consisted in using the DTM [noncommunicabledisease] platforms to really spread some of this change in social behavior around handwashing, said Khan. Messages on trachoma prevention, for example, have been adapted to the COVID-19 response. The provision of information and resources to partners aims to ensure that the response is inclusive for people with disabilities, he added.

Khan says the Ebola crisis in West Africa can provide lessons for the current response. Elective surgeries and activities involving mass gatherings were also suspended during this crisis. But at the time, the organization was more reactive when it came to services and ensuring access to protective gear, said Khan. With COVID-19, we were much more proactive … in terms and taking care of the health workers, he added.

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Staff security and supply challenges

As organizations try to maintain at least some of their services, the safety of staff is a high priority. Before the foreclosure of Ghanas, which only applied to two major cities, outreach activities that were mainly carried out in hard-to-reach areas continued without additional security measures in place, said Clarke. But as knowledge of the coronavirus developed, security measures were quickly introduced and the staff of the outreach team received masks and gloves for their screening work, he declares. The national ban on public gatherings has meant that these activities have finally been suspended, but medical personnel still working in clinics have all the necessary PPE, and social distancing is practiced in waiting areas.

At VisionSpring, mechanisms have been put in place to monitor the safety and symptoms of the organization’s large team. Before leaving the house each morning and after returning home in the evening, staff members perform a basic risk assessment and report any symptoms they experience, said Taneja. In addition to PPE, the organization has deployed its own vans, which are sanitized twice a day, to pick up and drop off workers. Insurance coverage, sick leave and daily allowances have all been increased to provide additional support. Joining the response was also completely voluntary for the staff, Taneja said, but the majority of the team was enthusiastic about doing so.

Although there is a shortage of certain medical products, access to medical equipment and supplies in general is not currently a problem for the organizations with which Devex spoke. Pharmacies remain open, couriers continue to deliver essential items, and existing connections in the healthcare supply chain can also help organizations quickly obtain government approvals to build PPE inventory.

However, access to these items may become more difficult in the coming months, and personnel and spare parts may not be available to service the equipment. There is a long enough delay for us to buy them and with a lot of activities interrupted, we don’t need a lot of this equipment immediately, said Khan. But when normal work resumes, there may be problems obtaining supplies for new programs where orders were not placed before the current crisis.

Post-coronavirus programming

Taneja noted that the persistent pandemic will change the way eye health services are provided, especially given the close link between the eyes and the spread of the virus. I see a change in what we are doing by having these infection prevention practices as part of the job, he said.

But he added that this response has created an opportunity to see the different ways in which VisionSpring can add value to people’s lives. For example, eye screening camps could be used for activities related to COVID-19 awareness, sanitation and hygiene education.

There will likely be an immediate and increased demand for eye care services once the restrictions are lifted; Clarke plans to have massive participation in community centers, which will force staff to double their workload and spend more time in communities.

More time will be needed for coronavirus health education, personal hygiene and protective measures in local dialects in addition to routine eye health education, he wrote. The rapid rollout of these activities and the reduction of the anticipated backlog of cataract surgeries will also require additional funds.

It is difficult to predict the overall impact of the current crisis, but Khan said there will likely be an increased demand for strengthened health systems equipped to meet the needs of the population in the event of an emergency. Sightsavers will focus on advocacy and working with partners, governments and international aid agencies to build more resilient health systems.

Devex, with the financial support of our partner Essilor, explores the challenges, solutions and innovations in eye care and vision. Visit the Focus on: Vision page to learn more.

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