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Community Eye Care in Nepal in the Era of COVID-19

Published: 11.08.2021
Samara Andrade SightLife
Kieran S O’Brien Francis I. Proctor Foundation
Ravindra Shaky Seva Foundation

Meet Dilmaya, a SightLife-trained Community Health Worker (CHW) from Nepal, who provides critical first aid eye care to low-resource patients in her community.  In partnership with Seva Foundation and the Francis I. Proctor Foundation at the University of California San Francisco, SightLife has equipped Dilmaya and hundreds of CHWs just like her in Nepal with the knowledge and tools they need to diagnose and treat corneal abrasions – helping prevent corneal blindness in nearly 12,000 patients since October 2017.

Through this program, Dilmaya helps patients apply just-in-time antibiotics to remedy infections before blindness sets in. Or, if a higher level of care is needed, she refers them to local health clinics. In both scenarios, patients benefit from the broader work of SightLife, Seva Foundation, and the Proctor Foundation to build capacity across the eye health system, and more specifically, the corneal care continuum.

For years, the three organizations have partnered to address preventable and treatable blindness in rural Nepal using innovative research-based solutions that strengthen quality eye health care capacity and impact. While this work was temporarily disrupted by the COVID-19 pandemic, key programmatic adaptations have helped it continue in a manner that has not only safeguarded the health of our frontline workers and their patients, but also ensured affordable, quality eye care remained within reach in the communities we collectively serve.

To address eye health inequities amplified by the COVID-19 pandemic, our strategic and comprehensive adaptations focused on:

  • Leveraging Current COVID-19 Data for Decision Making
  • Strengthening the Eye Care Health System’s Agility
  • Adapting Community Eye Care Programs
  • Preparing Community Health Programs for Reopening

Leveraging COVID-19 Data for Decision Making

All partners strongly believed evidence-based decision making was critical to resume fieldwork safely. As such, the Proctor Foundation took the lead to develop a district-level COVID-19 tracking dashboard, drawing on data available from the National Disaster Risk Reduction & Management Authority in Kathmandu as well as the Nepali Ministry of Health and population data for the country.

This dashboard allows program staff, community health workers, and eye hospital personnel to make data-driven decisions on in-person care and outreach using easily accessible and collated data on cumulative COVID-19 cases (prevalence), new cases (incidence rate), active cases, and deaths in Nepal in conjunction with benchmarks set by the U.S. Centers for Disease Control and Prevention.

Strengthening the Eye Care Health System’s Agility 

Early in the pandemic, Seva Foundation began supporting a cohort of eye hospitals in Nepal to develop standard operating procedures to ensure safety in outpatient eye care. Participant-led virtual workshops facilitated by Seva Foundation built a roadmap for how eye care programs can safely operate through the pandemic while still ensuring excellence in the delivery of care.

Participating hospitals took the lead in establishing protocols for registration, consultation, personal protective equipment, disinfection, instrument sterilization, biomedical waste management, needle stick injuries, and clean-up crews. Such protocols expanded the COVID-19 management capabilities of eye hospitals and strengthened the agility of the eye care health system overall, helping ensure patient needs could be addressed even during the pandemic.

Rapidly Adapting Community Eye Care Programs 

Prior to the pandemic, SightLife’s Prevention Program required in-person engagement between CHWs and their patients.

After briefly pausing operations in mid-March 2020, SightLife – with support from Excelitas Technologies Corporation and the Alcon Foundation – rapidly developed remote operating procedures and community health worker competency frameworks that used cell phone-based monitoring rather than in-person visits and educational calls in lieu of CHW refresher trainings. In addition, SightLife provided personal protective equipment (PPE) and updated eye care and COVID-19 information brochures to all community health workers and hospital staff.

SightLife further evolved its CHW refresher trainings by transitioning their remote learning model to one where trainings were safely conducted in outdoor venues. The number of trainees was additionally reduced, and all wore face masks and protective shields during the training activities.

Preparing Community Health Programs to Safely Resume Eye Care Activities

In close partnership with the Bharatpur Eye Hospital, SightLife and the Proctor Foundation also developed new COVID-19 procedures which laid the groundwork for a safe resumption of activities that support community eye health as well as ongoing research. These new procedures were shared through virtual trainings in preparation for fully vaccinated staff operating under new in-person procedures. SightLife also provided group-level and 1:1 mental health support to staff in recognition of the additional stress and isolation of being a frontline worker during the pandemic.

Working Together for Sustained Impact

By working together with our partners and the communities we serve, SightLife, Seva Foundation, and the Proctor Foundation were able to sustain our proven programs across the continuum of community eye care even during a global pandemic. And yet, the pandemic is far from over, especially in Nepal, where a devastating second wave of COVID-19 continues to overwhelm health systems. While it’s clear the pandemic will not end anytime soon, our partnership proves that eye care programs can adapt to the moment safely and effectively – centering patient and provider needs every step of the way.