Refugee eye care

Syrian mission shows value of paediatric screening, cataracts, local collaborators

Howard Larkin

Posted: Thursday, July 30, 2020

Natalie Weil MD with a patient at the Zaatari refugee camp, Jordan. Courtesy of Nathalie Weil MD

At Jordan’s sprawling Zaatari refugee camp, just a few miles from the Syrian border, 40% of the approximately 90,000 occupants are under 18 years old and 60% under 24. In a pilot study conducted by Emory University ophthalmologists, about 30% of children failed a new innovative vision screening test, with uncorrected refractive error, eye motility problems and amblyopia being the most common causes.

The scope of these issues is one reason why Atlanta, USA-based Emory University, in partnership with the Syrian American Medical Society (SAMS), made paediatric vision screening one of its top priorities for its multi-year mission in the camp. The team has thus far provided eyecare to about 16.5% of the paediatric and 7% of the adult population, Emory’s Soroosh Behshad MD, MPH, told the ORBIS International Symposium at 37th Congress of the ESCRS in Paris.

“We hope to get to 100%, but that is pretty good for the first three years,” he said.

The Emory team hope to greatly expand that figure by putting portable screening devices from Plusoptix and GoCheck Kids into the hands of specially trained staff at all SAMS clinics in the camp, under supervision of a local ophthalmologist. To address the refractive error issue, Emory hopes to install an optical dispensary at the camp to provide low-cost spectacles quickly. Working in parallel with the paediatric vision screening program, the team also has an established cataract surgery programme to help address the top cause of adult blindness in the camp.

“In having the opportunity to offer cataract surgery and glasses we can have a huge impact on reducing reversible causes of blindness with this population,” said Dr Behshad, who was once a refugee himself and whose family fled from Iran due to religious persecution.

Ophthalmic medical education rotations with two Jordanian medical schools, and mini-residency programs in a range of ophthalmic sub-specialties also have been established. The goal is to build local capacity of the host country and increase access to subspecialty services, especially glaucoma, paediatric, and retina care – for both refugees and the host country’s population, said Emory’s Natalie Weil MD.

Natalie Weil MD with a patient at the Zaatari refugee camp, Jordan. Courtesy of Nathalie Weil MD

Yet ambitious as this project is, it barely scratches the surface of unmet refugee need. Jordan alone has 1.4 million Syrian refugees and 4.3 million refugees overall, making up 46% of the country’s population. Worldwide, there are about 70 million displaced persons, of which about 26 million are refugees living outside their home countries. They are not evenly distributed. Nearly half live in six countries that make up less than 2% of world GDP, while just 8% live in the six richest countries that make up 56% of world GDP.

Helping them, particularly in refugee camps, involves challenges that ophthalmologists must be ready to meet to succeed, Dr Weil said. One is a lack of predictability.

“There is a plan, and then there is what actually happens,” Dr Weil said.

Since camps have heavy security, clinic personnel don’t always have access when they plan to and may be sent home early. Access to equipment is also a challenge.

“You need to figure out how to be effective on the spot.”

Lack of subspecialty care is a problem, especially for glaucoma and retinal emergencies.

“In many cases, we have to find local Jordanian colleagues and partners to do many of the needed surgeries,” Dr Weil said.

Follow-up care can also be difficult because refugees are mobile and may not be in the same camp on a return visit, Dr Behshad noted.

The best way to prepare is sharpen your skills, Dr Weil said.

“You are going to see a lot of different pathology. It can be overwhelming, so be sure to prepare.” But she warned against doing procedures outside your expertise. “I don’t do anything I wouldn’t do in daily practice.” For surgeons who cannot travel to Africa or the Middle East, Dr Weil suggests looking for refugee settlements locally.

“A lot of time you can find people who need help right in your neighbourhood.”

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