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Alamgir Hossain examines a patient © Zul Mukhida/Sightsavers
Behind the scenes at the Bangladesh Childhood Cataract Campaign
Dr Alamgir Hossain is programme co-ordinator for the Childhood Cataract Campaign in Bangladesh. He joined Sightsavers in September 2004 with an impressive track record in healthcare. As well as being a public health physician with extensive work experience in health development and management, Dr Hossain has also acted as consultant to a range of UN agencies and non-governmental organisations. Originally from Barisal in southern Bangladesh, he lives and works in Dhaka. Dr Alamgir Hossain runs a dedicated team to implement the project, consisting of Mahmuda Alim, Anwar Hossain and Ashtaq Joarder.
In 2004, Sightsavers pledged to track down every child in Bangladesh who is needlessly blind due to cataract and restore his or her sight through a simple and inexpensive operation. The first programme of its kind in the developing world, the campaign will prove an important model for other countries.
We talked to Dr Hossain about the progress that has been made and the challenges that still lie ahead.
What is the extent of blindness due to cataract in Bangladesh?
Cataract accounts for 80% of adult blindness in the country and there are currently somewhere in the region of 550,000 to 750,000 adults who are blind as a result. Of the 40,000 children who are blind, one third of this is due to cataract so there are some 12,000 youngsters who could benefit from sight-restoring surgery.
What stage is the Childhood Cataract Campaign presently at?
Our aim is to provide surgery for at least 10,000 children and support for 20,000 surgeries. To date, we've identified and provided support to over 12,000 surgeries so we're on target to achieve our objectives. So far, we've succeeded in restoring sight to over 4,114 blind children from approximately half of the country with the help of our case-finding partners. So the next step is to track down unidentified individuals from the present areas as well as from the remaining half and then to ensure that the proper follow-up takes place once surgery has been carried out. We are also developing a database of 40,000 blind children.
Last year, 4,114 children were saved from blindness - how did that make you feel?
When I go out into the communities and meet the children who have benefited from surgery, I can't begin to express the reaction of their parents and neighbours. They never thought that the children would be able to see this wonderful world that we live in again. I feel very fortunate to be a part of something so miraculous. Imagine what it must feel like for a mother to see her son able to ride his bicycle along the highway or playing cricket with his friends - to know that his sight has been restored and he has his whole life ahead of him.
What do you consider to be the key successes so far of the Bangladesh Childhood Cataract Campaign?
The fact that we've already been able to help so many children through the campaign is clearly a major success story. But I'm also very happy that we've been able to identify some of the younger children - cataract surgery really needs to take place by the age of two in order to ensure the best possible outcome as any later and it becomes much harder for the brain to be able to "learn" to see.
What are the main challenges currently facing you in order to achieve the target of 20,000 cataract operations?
Finding sufficient funding is always an ongoing challenge, as is actually tracking down the children affected by cataract. It's also crucial that we encourage parents to stick to the correct follow-up procedure. The difficulty is that when the child can see again, parents are often reluctant to bring them back to be examined so counselling them as to why it is necessary is an important part of our job.
What processes are being put in place to help children whose sight can't be restored?
A database of children who are irreversibly blind will be established, enabling us to provide them with better opportunities for schooling and inclusion in our community-based rehabilitation programmes. Children who have operable eye conditions other than cataract will also be referred for appropriate treatment.
What do you think the significance of the campaign will be with regards to acting as a model for other countries to follow?
Our experience in Bangladesh will help other countries to design more effective and realistic projects. Hopefully, it will provide a model to follow when it comes to case identification, clinical guidelines, database management and surgical outcomes.
What will the Bangladesh Childhood Cataract Campaign's legacy be?
Our intention is to eliminate the backlog of cases of children needing cataract surgery but of course there will be new cases that continue to come along. But we will have improved and strengthened paediatric eye care facilities across the country and instigated far more effective referral systems from primary through to tertiary level. All of this means that Bangladesh should be in a far better position to address the issue of childhood blindness, and specifically cataract, in the years to come.
