My volunteering experience: vision and empowerment in rural Bihar

For advice, I approached my former lecturer, Shehzad Naroo at Aston University, ahead of the trip. He recommended that I visit an eye hospital in Bihar. After spending two weeks volunteering there, I can say that this is one of the most innovative and impactful eye care projects I have ever encountered.

Located in Mastichak in the heart of Bihar, Akhand Jyoti Eye Hospital (AJEH) has created something truly remarkable. Since 2005, it has grown from a small clinic to become the largest eye hospital in eastern India, completing over one million sight-restoring surgeries.

But what sets AJEH apart isn't just its scale – it is its revolutionary approach to solving two of Bihar's most pressing challenges simultaneously: preventable blindness and gender inequality.

The challenging reality in Bihar

Bihar used to be one of the richest areas in the world, and some of the great old Indian empires were based here. It is a beautiful place to visit. However, in recent decades it has gone through difficult times. According to the Multidimensional Poverty Index, Bihar has one of the highest poverty rates in India. The state also ranks near the bottom of the UN Gender Development Index, with female literacy rates far below males and low numbers of female labour force participation.

In the rural context, eye problems are particularly devastating. Rural areas see far more eye conditions than urban centres, yet have dramatically fewer resources. The frustrating reality is that 80% of blindness in these regions is preventable or treatable.

Enter the pyramid model

AJEH follows a four-tier ‘pyramid’ structure, which brings eye care directly to where it is needed most. At the base are 33 (and counting) primary vision centres, strategically positioned throughout rural communities for consultations, post-surgical follow-ups, and spectacle dispensing. These feed into secondary centres – smaller 40–60 bed hospitals, performing cataract surgeries. Above these sit tertiary centres, offering multi-specialty eye care.

Finally, is their state-of-the-art Centre of Excellence, in Mastichak – remarkably, the world's first such facility located in a rural area. This pyramid structure allows them to perform 90,000 surgeries annually, with 80% provided free of charge to the most disadvantaged patients.

Benji’s volunteering experience in Bihar, eastern India

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Football to Eyeball: A game-changing programme

An innovative aspect of AJEH’s work is its ‘Football to Eyeball’ program. In a deeply patriarchal society where child marriage, dowry demands, and domestic violence remain prevalent, getting rural girls into education – let alone healthcare careers – requires creative thinking.

Football becomes the ice-breaker. By encouraging girls to play, the programme immediately challenges social stereotypes. But this is just the beginning. The girls who show interest are then offered something genuinely life-changing: a completely free optometry degree, accommodation, food, and the promise of meaningful employment upon graduation.

During my time there, I had the privilege of teaching some of these remarkable young women. Their stories were consistently powerful – many came from families where no woman had previously worked outside the home, yet here they were, learning to perform sophisticated eye examinations and planning to return to their communities as qualified healthcare professionals.

The ripple effects are immense. These graduates don’t just provide eye care – they become role models, proving to other families that educating daughters can transform entire communities. AJEH aims to employ 1500 female optometrists by 2030, creating a workforce that truly understands the populations they serve.

The girls who show interest are then offered something genuinely life-changing: a completely free optometry degree

Teaching in challenging circumstances

My own experience began rather dramatically. Having mentioned I was happy to do some informal small group teaching, I found myself facing 100 optometry students in a lecture hall on my first day, with no specified topic and instructions simply to ‘talk about whatever you think would be helpful.’ And this was my first time teaching a large lecture.

What followed was a week of lectures across multiple campuses, reaching around 300 students, from first-year undergraduates to pre-registration optometrists. I discovered that approaches we consider basic in the UK could be genuinely eye-opening in this context. In the UK I still feel relatively junior in the optometry field, but in contexts like this I have learned I have a lot to offer. I began to understand some of the needs of the students, and I am in the process of helping refine the curriculum, so when future volunteers visit, they will know what is best to teach.

One memorable session involved teaching Volk lens examination through undilated pupils. The excitement when the pre-reg students successfully saw the optic disc was infectious. Their pre-reg training had emphasised hands-on experience from the very start, and I was able to supplement that learning and offer a different perspective. In leading lectures and practical sessions on common optometric techniques, I was able to share best practice from optometry in the UK.

Lessons for global eye care

What strikes me most about AJEH is how it challenges conventional approaches to international development. Rather than simply providing aid, the hospital team has created a sustainable ecosystem where local women become the solution to their community's problems. They are proving that with innovative thinking, even the most entrenched social and health challenges can be addressed simultaneously.

The hospital team has created a sustainable ecosystem where local women become the solution to their community's problems

My time in Bihar reinforced several crucial lessons about international eye care work. Firstly, that the most effective interventions often address multiple problems simultaneously. Secondly, sustainable change requires local ownership – relying on external experts to fly in occasionally is far less effective than empowering local people to become experts themselves.

Finally, it reminded me that some of the most innovative healthcare solutions emerge from resource-constrained environments, where creative thinking isn’t optional – it’s essential.

As I returned to the UK, I brought back not only memories of inspiring students, but also a renewed appreciation for how optometry can be a force for social change. AJEH demonstrates that eye care isn’t just about vision – it’s about dignity, opportunity, and hope.

For any optometrists considering international volunteering, I’d encourage you to seek out projects like AJEH that go beyond simple service delivery to create lasting change. The experience will undoubtedly transform your understanding of what is possible in our profession.

In a world where 2.2 billion people live with vision impairment, and where gender inequality remains a persistent barrier to development, projects like AJEH show us a way forward. They remind us that with courage, creativity, and commitment, we can make a real impact – one eye exam, one surgery, and one empowered young woman at a time.

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