Sushant Wagley: Ophthalmology in Nepal

Project Proposal

Nepal is a developing country with a weak healthcare infrastructure, which was severely damaged during the civil war that lasted from 1996-2006. Currently, Nepal is in a post-conflict reconstruction phase that has been filled with political instability and slow economic development. While healthcare development is seeing a slow improvement, access to healthcare is still an issue for many Nepalis. For many in rural underserved areas, government health and sub-health posts (most of which carry only basic and often expired medications) act as the only access point to medical care. However, one area of medicine that has seen advanced development in Nepal has been the field of Ophthalmology. Both primary (refraction and general/screening eye exams) and surgical eye care (especially cataract extraction) are commonly performed (with exceptional results) at various levels ranging from tertiary referral centers in the capital, to community hospitals at the district level, to community based programs in rural villages and towns. One interesting and effective approach to eye care at the community level in rural areas has been via outreach microsurgery eye clinics (OMEC). During OMECs hundreds (sometimes even thousands) of people are screened for vision disorders and many are treated with surgical and nonsurgical interventions on the spot. Many studies have examined the outcomes of these interventions and have shown OMECs to be effective in improving vision and reducing the burden of vision loss. However, there are only a few studies examining how these outreach models are designed and implemented. My proposed study aims to examine these community based diagnostic screening and treatment programs in terms of design, cost, implementation, and efficiency.

From June – August 2013, I plan to work with BP Koirala Institute of Health Sciences and its affiliating community based hospitals to complete this project. More specifically, from June – July I will be coordinating, from the United States, with administrators in Nepal to collect administrative data to compare various past programs, and will be simultaneously be preparing for my travel to Nepal. For July and August, I will travel to Nepal to observe these outreach clinics first hand. I will also gather data on per patient costs, equipment utilization, and will record challenges experienced during these clinics. Data collected from the recent programs will then be compared with data from the past programs to examine how these outreach clinics can be changed and improved. From this study, I hope to not only develop conclusions for improving these outreach eye clinics, but also hope to develop models that could be adapted for other community based medical programs implemented in rural settings.

This project stems from my educational interests in understating how effective medical care can be brought to rural underserved areas through a relatively cost effective model. I will be working under the direct supervision and direction of Dr. Manoj Sharma, who has led multiple outreach eye clinics throughout Nepal and has also been involved in educating providers outside of Nepal to develop similar outreach programs. I strongly believe that my five years of experience in community based healthcare development in rural/urban-underserved areas within Nepal, my mastery of the language, and my understanding of Nepali culture will help me undertake this project. At the end of the project, I plan to compose a manuscript and submit my results for publication in hopes that lessons from Nepal can be applied in settings around the world and in fields outside of Ophthalmology.

 

Proposed budget:

Tickets DTW-KTM-DTW: $2300

Student lodging at BP Koirala Institute of Medicine: $10/day x 25 days = $250

Nepali Visa Fee: $90

Travel/food costs within Nepal (buses and lodging for rural clinic travel): $200

 

Total requested budget: $2840