Optimizing locally available resources to increase Tibetans' access to eye care
For 35 years, Seva has been combatting avoidable blindness and visual impairment in developing countries. For 12 years, Gongga Zhaxi, Seva Tibet Program Director, has channelled his passion for public health and VISION 2020 by expanding eye care services in Tibetan areas within China.
Under Gongga’s leadership, a quarter million people received eye examinations, 56,158 people received sight-restoring surgeries, 85 eye care professionals received training, and 12 eye care facilities were established in an area where a population of 4.6 million people inhabit 170M square kilometers.
Dr. Marty Spencer, Seva Volunteer Ophthalmologist and Board Member stated, “I’m delighted to see Gongga Zhaxi’s nomination. Having worked very closely with Gongga and visited Tibet several times, I have seen the impact of his work first hand. Gongga works tirelessly to increase the effectiveness of Seva’s Tibet Sight Program. He has an uncanny ability to identify local surgeons for training by Seva volunteer ophthalmologists, thereby greatly increasing the number of Tibetans receiving cataract surgery, especially in remote and underserved areas. Gongga builds excellent relationships with country partners, the health ministry, and local hospital officials. He is respected locally and internationally for his entrepreneurial spirit and dedication to service.”
Gongga faced many challenges providing eye care services to underserved communities in Tibet. One particular challenge is the dispersed nature of the population within a huge geographical area. The population density in Tibet is 6 individuals per square mile, whereas density of population in India is 900 per square mile. Eye care facilities in Tibet are interwoven with government hospitals; as a result, there exists a lack of operating space and operating days for eye patients which is problematic.
Additionally, the cataract surgical outcomes were poor as a result of couching and intra-capsular cataract surgery techniques, techniques which are now obsolete. Another challenge was the sustainability of the service delivery model, as most of cataract surgeries were conducted in eye camp settings by visiting ophthalmologists. Once the eye camps are finished, the local team must facilitate the work and take care of the post-operative patients. Other challenges include the high cost of cataract surgery. Furthermore, illiteracy, isolation and poverty are significant barriers to accessing care. Public transportation does not exist for patients and serves as a major barrier to access. Blindness is attributed to fate in Tibet.
To address the aforementioned problems, Gongga maintained a low profile and discouraged cataract surgical missions led by foreign teams. He sent teams of local surgeons and ophthalmic assistants for training on high volume extra-capsular surgery with intraocular lens implantation in neighbouring countries. He introduced day surgery and negotiated with government officials to establish separate operation rooms for eye patients. He also got permission to import high quality low cost medical and surgical supplies outside China. As a result, the quality of cataract surgery improved and the cost for services decreased enabling more patients’ access.
Gongga eliminated barriers imposed by geographic and administrative boundaries. Gongga increased access by planning outreach surgical camps regularly in centrally located areas by local teams. He used the television and radio to broadcast such events and also used cell phones/ text messages to attract patients. Through a series of TV reports focusing on the growth of Tibetan eye care professionals and the impact of surgery on patients, the cataract surgical acceptance rate increased. The above efforts have helped achieve cataract surgical rate of 2000 in Tibet, which is two times higher than the national cataract surgical rate in China.
Gongga has been able to optimize the available local resources and build the capacity of a tiered network of eye care providers within the government network ranging from rural health workers, to county level doctors to prefectural level eye care providers.