An Indian mission

Specialist optometrist at Moorfields Eye Hospital, Rajula Karania, shares her experiences of training an ophthalmic team in Bihar, India

Rajula Karania treating a patient in India

Having completed all of my post graduate training around two years ago, I found myself thinking: ‘What now?’ I certainly had an urge to do something different.

Then, one day, an email appeared in my mailbox that caught my eye. It read: ‘Optometrist urgently wanted in India.’ Curiosity got the better of me and I hit reply.

An ophthalmologist called Lucy Mathen was desperately seeking an optometrist to travel to Bihar in India to train a local ophthalmic team.

I immediately felt a sense of excitement and remember thinking that this was an opportunity not to be missed. It was a chance for me to give back to the community and share the skills that I had learnt during my career as a hospital paediatric-specialist optometrist.

I had been looking for an opportunity to go and do voluntary work abroad, particularly teaching. That said, the remote north eastern state of Bihar was unknown to me.

Moorfields to Bihar

Ms Mathen founded a charity called Second Sight, which aims to cure treatable blindness in the state of Bihar by providing free cataract surgery to some of the poorest people in the state who have no access to healthcare.

Second Sight has six partner hospitals across Bihar, each working to irradicate reversible blindness in a specific region of the state.

Prior to my trip, a new paediatric unit had been established at the Laxman Eye Hospital and an optometrist was needed to train a few local ophthalmic assistants who had already undergone a local government-run optometry course, but had very little practical skills in vision testing and refracting children. The team was already screening children for congenital cataracts, but was unable to provide, pre- and post-operative care with refraction. This is what I would be there to do.

"It gave me a platform to step out of my comfort zone and undertake a teaching role. It was an immense learning curve for the local team too, who mastered the techniques incredibly well"

When in India

With a leap of faith, I agreed to take on the challenge and I was soon on my way to Laxman Eye Hospital in Muzzaffarpur. The two ophthalmologists and the director of the hospital welcomed me on my arrival and the hospitality of all the staff was overwhelming.

Retinoscopy is quite a difficult technique to teach as it is a practical skill where the person demonstrating cannot see what the trainee sees, and vice versa.

This was further complicated by having to teach in Hindi, which, although I claim to speak fluently, is not my mother tongue. Needless to say, translating some of the ophthalmic terminology in to Hindi was a huge challenge.

Training days were long, combining formal theoretical teaching and practical work.

The patients had travelled for hours to get to the hospital, with some children dressed in their best clothes for the visit. What struck me was how well behaved they were, sometimes not having anything to eat or drink for hours while waiting, and then sitting quietly for a few more hours while the trainees practised on them.

In the UK, we would be putting ourselves at risk if we tested children without their parents in the consulting room, but this was the norm in Bihar. In total, we saw around 80 children, aged one to 17 years, in a week. A large proportion of the people we saw had uncorrected refractive error and were in dire need of spectacles.

The other single-most important cause of childhood blindness in India, and worldwide, is from Vitamin A deficiency, which causes xerophthalmia and night blindness. I had never seen this pathology before, yet it was a common finding in Bihar. Children presenting with corneal ulcers and Bitot spots was also common. A new interventional research project, FAME (Food, Vitamin A, Measles vaccination and Education), was launched by Second Sight while I was there to address this problem and help prevent it.

Ophthalmic team in Bihar, India

Career development

This was an extremely satisfying and rewarding experience. It gave me an opportunity to step out of my comfort zone and undertake a teaching role. It was an immense learning curve for the local team too, who all mastered the techniques incredibly well and are now able to provide ophthalmic care to the underprivileged children attending the new paediatric clinic.

For more information about Second Sight, visit its website.

Rajula Karania is a specialist optometrist at Moorfields Eye Hospital. She is an independent prescriber, and holds a post graduate diploma in ophthalmology and a Masters in clinical optometry.