Posted on 28 Jul 2019

Eyesight Restoration Surgery

There is a huge backlog of simple sight restoring surgeries in Myanmar due to decades of neglect, environmental conditions and increasing life expectancy.

Tipitaka Cakkupala Eye Hospital (TCEH), Htee Saung is a community based hospital that is well positioned to serve the impoverished communities of this arid zone. The Sayadaw (senior monk), U Wunthe Pala Linkara, who also oversees the work of the hospital, has a solid track record. The surgeons, nurses and sponsors have maintained a highly-regarded service in general medical and surgical management of challenging health problems for over five years.

The DAK Foundation work closely with TCEH and The Charitable Foundation Nepal (CHFN) to conduct cataract surgeries for people in need. CHFN provides skilled ophthalmologists and TCEH provides the patients, the facilities, post-operative and follow-up care to patients. The project is closely monitored by the DAK Foundation as well as the Sydney based Myanmar Eye Care Program (MECP)  and the program is evaluated on an on-going basis.

In 2016, we funded over 39,000 surgeries in this area. That is a huge number of people for whom daily living is now possible due to the restoration of eye sight.

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Posted on 28 Jul 2019

Safe Anaesthesia in Somaliland, SANSOM

The World Health Organization (WHO) and World Bank expect that by 2026, the burden of diseases requiring surgery and anaesthesia will eclipse that of HIV, tuberculosis and malaria (measured in disability adjusted life-years). However surgery and anaesthetic care has long been “the neglected stepchild of global health”. (1)

The global volume of major surgery in 2004 was between 187 and 281 million cases, meaning approximately one in every 25 people underwent an operation requiring anaesthesia. It is estimated that five billion people worldwide do not have access to surgery, let alone safe anaesthesia. 75% of major operations were performed in the wealthiest third of the world’s countries, while the poorest third of the world’s population underwent only 3.5% of operations. This reflects a profound disparity in access to essential surgery and safe anaesthesia and a large, untreated global burden of disease.

After decades of civil war, the challenges faced by Somaliland are huge. With a poorly functioning health system there is a lack of education, equipment, supplies, and skilled health personnel and very few facilities in rural areas.

An anaesthesia training programme for Somaliland was instigated three years ago by Dr Mark Newton, Associate Clinical Professor based at Kijabe Hospital, Kenya, but once the nurse anaesthetists got back to the more rural hospitals they had little or no anaesthesia equipment to work with. This has not only been a problem for the hospitals and the patients but also does not encourage the newly qualified anaesthesia providers to stay in country.

We have partnered with Diamedica, UK on an innovative project that aims to make major improvements in anaesthesia provision and care in rural areas where standards are lower and few funds are available. The provision of general anaesthesia in rural regional areas can be made much safer and readily accessible by the use of equipment which has been specially designed for such difficult circumstances.

The project, called SANSOM, provided CME training and equipped the anaesthetic nurses with appropriate equipment before they returned to the rural hospitals. Pairs of trained anaesthetic nurses can thus provide care in a rural setting.

The provision of appropriate medical equipment that is simple, robust and long-lasting is a crucial part of this project, along with training and follow up.

Diamedica manufactures anaesthesia machines designed for challenging environments, and these, along with medical kits which included Lifebox pulse oximeters were given to eight hospitals in Somaliland.

Critically, the anaesthesia machines function well in places susceptible to power failures, or where a reliable supply of oxygen is unavailable, as is the case in Somaliland – and many other LMICs.

Specifically, the DPA02 anaesthesia machines donated continue to function when the electricity fails, and the oxygen concentrators also provided create their own oxygen. In addition, since the anaesthesia machines are portable, they may be used for outreach work, if necessary.

Through this project, delivery of safe anaesthesia for general surgery and safe emergency obstetric care in rural hospitals and clinics will save the lives of thousands of vulnerable women and babies.

A group training programme has been completed as part of Phase 1 of the project for 34 anaesthesia technicians and safe anaesthesia kits have been provided to eight hospitals.

Photo Credits: Tim Bekir​

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Posted on 28 Jul 2019

Impact Foundation Bangladesh

Impact Foundation Bangladesh (IFB) has been working in Bangladesh since 1993 and their mission is to improve the lives of disadvantaged people and their communities.

We work with IFB with a project called ‘Proshanti’ (which means enjoying peace and tranquillity). The aim of the project is to provide free surgery for disadvantaged women suffering from prolapse. Living with prolapse is a huge stigma for women and they can often be ostracised from their communities, or be considered cursed.

The incidence of prolapse in South Asia is huge. Research has been done in Nepal which estimates that there are up to 600,000 women (of a population of 27.8 million) suffering from prolapse in that country. With a population of 166 million in Bangladesh, not much research has been done on estimating prolapse numbers in the country. However a recent research study, one of the first to be done on Pelvic Organ Prolapse (POP) incidence in Bangladesh, estimates about 1 in 6 women in rural Bangladesh suffer from POP (about 15.6%). Increasing age and parity are risk factors for POP and are in line with previous studies. Hence, it is safe to conservatively estimate a huge need for this project.

We work with local Bangladeshi gynaecologists (12 in 2017), who provide surgery to poor women who are unable to afford the cost of surgery. In 2016, 10 local Bangladeshi surgeons have been trained in a new technique of surgery that is not taught in Bangladeshi medical schools. In 2017, it is anticipated that two more surgeons will be trained. Each trained surgeon performs a maximum of 20 surgeries per month based on a set criteria for assessment of the degree of prolapse. These are monitored by detailed patient forms and follow up calls to a random selection of patients to gather feedback. In addition, postoperative observations are also recorded by the participating surgeons.

We are excited by this project because it is like no other in Bangladesh at the moment. With several local Bangladeshi surgeons trained in this new technique, there is scope to train master trainers, who can then train younger gynaecologists who will specialise in the field of birth injury repair. This project will have a cascading effect on the medical community by building the knowledge in Bangladesh.

The program is set to deliver 8,500 surgeries over the three year period 2017-2019.

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