Need for private-public partnership for promoting eye health as a human right

Using philanthropy as an unprecedented country-wide solution to prevent avoidable blindness for Sri Lanka’s poorest people – opens vistas for promoting stronger policymaking for equality in eye care health. This will spearhead the concept of private-public partnerships that assist the State health system in times of the current economic crisis

By Surya Vishwa 

Harmony is a concept that blends different strands to give meaning to the integrated whole. Hence, within this construct, this article is part of a series that hopes to understand the socio-cultural significance of preventing blindness of a nation. In different segments in the weeks to come, we will be looking at vision and the related impact to the rural and national economic framework, including arts, crafts, the aesthetic and the entire knowledge based economy; in essence how vision is the very core of human capacity and linked to national economic growth. 

Thereby we will be examining the relevance of eye health through the lens of equality of the 2030 agenda of Sustainable Development Goals initiated by the United Nations. Analysing eye health from an equal rights perspective this introductory article will look at the importance of philanthropy for broad-basing eye care rights for marginalised and low income groups, focusing on the Sri Lankan context. Thus this article series will capture some significant interviews with healthcare representatives associated with the Vision 2020 program that was then under the Ministry of Health in Sri Lanka and include commentaries and narratives from few set of stakeholders who supported Vision 2020 and the current 2030 Insight program. 

We will especially look at the concept of philanthropy in eye care, especially for the marginalised. In a country that values the meritorious act of giving or dana, the bestowing of sight as charity has much scope for the elevation of awareness of the potential for doing good through donating to eye hospital surgery needs.

To promote the potential of wider awareness for eye care based social responsibility involving ordinary citizens, interviews for this article series will be gathered from a wide sociological framework that includes ophthalmologists and citizens involved in eye care fund raising.

It is hoped that featuring the silent work of a few individuals for over a decade will weave together the narratives for much needed social awareness relevant to look at the prevention of blindness as a social need and as an elimination as a social problem. This is aimed at beginning the discourse for linking eye care with rural economic strengthening, social responsibility and philanthropy. The need to look at both Western and Traditional Medicine (including traditional diet) based routes for promoting eye heath will be discussed in the background where the yesteryear knowledge of surgical expertise of the traditional medicine era being now completely lost.

In this initial article the work and views of ophthalmologist and head of the Vision 2020 national program, Dr. Asela Abeydeera and Jaffna based ophthalmologist, Dr. Muthusamy Malarawan, who is affiliated to the Jaffna Teaching hospital Eye Ward show the importance of raising awareness among philanthropists and fundraisers for eye care to be seen not just as a condition connected to general health but as a concern directly linked with the individual and national economy.

Dr. Asela Abeydeera is currently Community Eye Doctor at the Ministry of Health of Sri Lanka and Founder President Association of Community Ophthalmologists of Sri Lanka. He was a pioneering innovative influence that helped steer forward private partnerships to assist the national program for the prevention of blindness in his capacity as national coordinator of the Vision 2020 program of the then Ministry of Health.

He had managed to network with a wide segment of Sri Lankans at local and international level to promote social consciousness including those of expatriate Sri Lankans to assist the goal of eliminating blindness. 

“I was appointed head of the Vision 2020 program of Sri Lanka which began in 2007 and continued till 2017 as a health ministry initiative parallel to the global collaborative program between the International Agency for the Prevention of Blindness and the World Health Organisation (WHO) which was envisioned internationally around 1999. The vision 2020 program was successful in raising public awareness and contribution. Expatriate Sri Lankans started to take proactive steps to assist in the three core areas of focus; infrastructure development, human resource training and development and disease control,” he explains.

“There were several eye specialists of Sri Lanka who had migrated and who were assisting in facilitating overseas training for Sri Lankan eye care health practitioners. By this time several other individuals and organisations who became interested in post 2009 development in Sri Lanka began assisting the Vision 2020 program. Dialog, Sampath Bank and Orange Electric are among the business organisations that have very generously assisted the Vision 2020 program. There were many individuals in Sri Lanka and abroad who assisted us,” he states.

Explaining the link between education, economy and development Dr. Abeydeera points out that that between around 3 to 5% of the school going student population suffers from diverse vision impairments and that correction of these issues directly impacted their academic and exam performances.

“We directly witnessed this, where after providing eye care assistance such as eye glasses that students who were ranked last in class were making significant improvements. What was thought to be academic inefficiencies were in fact sight-related defects,” he stated. 

Using global statistics he notes that untreated cataract is the chief cause of blindness and that over 60% of cataract issues impact those above the age of 40 years. 

Eye care health in Sri Lanka is not segmented with budgetary allocation as with diseases such as Malaria, HIV and Leprosy which makes philanthropic assistance especially from Sri Lankans overseas, a significant contribution to assist free eye care assistance for low income persons. Interviews and discussions with those part of the rural agrarian economy show that eye care is non affordable by these communities. 

Meanwhile a positive post-2009 development in the eye care health goals of Sri Lanka was that talented and committed ophthalmologists such as Dr. M. Malarawan, Consultant at the Jaffna Teaching Hospital was able to freely work with his colleagues across Sri Lanka and thus contributing to the unity and reconciliation of the nation. He is today a much known name in the South and has led hundreds of mobile eye care camps across the country and currently compiling detailed research and public presentations working with rural most patients across the country. Dr. Malarawan could be described as a leading visionary in promoting eye health as a core component of Sustainable Development. 

A visit to the Jaffna Teaching hospital eye ward where Dr. Malarawan practices, is a very pleasant surprise. Young nursing and medical staff from around the country – such as Polonnaruwa, Hambantota, Galle and Trincomalee are represented. They work with fastidiousness and visible empathy and kindness to patients. The ambience of the hospital is more like that of a sunny and airy hotel than a hospital. The walls are adorned with colourful pictures of scenery, elephants and birds. The floors are cleaned often and the fragrance of a garden pervades this entire space.

“The Eye ward of the Jaffna hospital has been contributing significantly to preventing blindness in Sri Lanka. With the assistance of private partnerships we have provided free eye care screening and surgery for areas outside Jaffna such as Padaviya, Medawachchiya and Kepitigollawa. Free surgeries for Sinhala farmer communities of these border areas have taken place at the Jaffna teaching hospital for the past three years with the assistance of philanthropic organisations,” stated Dr. Malarawan. 

Initiating the celebration of all religious festivals in the Eye Ward of the Jaffna Hospital, and transforming eye care into a nation uniting humanitarian service, Dr. Malarawan has made headlines in several Sinhala newspapers and is a well-known personality amongst regional Sinhala media correspondents in Anuradhapura and Vavuniya areas.

Dr. Velautham Sarveswaran has been for around a decade a consistent fundraiser internationally for eye care in Sri Lanka through the UK-based charity, Assist Resettlement and Renaissance (ARR), since 2013 which support around 25 ophthalmologists across Sri Lanka – including areas such as Colombo, Kandy, Ampara, Karapitiya, Nuwara Eliya, Ratnapura, Embilipitiya, Mahiyangane, Kegalle, Gampaha, Chilaw, Puttalam, Kanthale, Polonnaruwa, Mannar, Vavuniya Mullaitivu and Jaffna. 

Mobile eye care screenings have been organised with collaboration with many stakeholders such as the Regional Directorate of Health Services (RDHS) and the Tri-forces. One of the last eye screenings to be carried out is in Pudukudiruppu which had over 480 civilians registering for the service coordinated by the civil affairs unit of the Lankan military.

It is learnt that Ophthalmologist, Dr. Ayasmantha Peiris of Ratnapura is to shortly collaborate with Dr. Malaravan to organise a Jaffna-Ratnapura friendship cataract surgery camp to be supported by ARR. 

“I am originally from Karaveddy in Jaffna and an engineer. I have been involved in assisting Sri Lanka’s post 2009 development in the areas of livelihood, healthcare, water, shelters and sanitation and education since 2013. Funding cataract surgeries is a key area that we are involved with and we daily receive requests from different hospitals in Sri Lanka for assistance for lenses (Intra Ocular Lens, IOL) and consumables such as knives, drapes and eye drops. I lead the operations in raising funds in the UK and around the world for all humanitarian work including eye care, medicine and even dietary and transport requirements for those who cannot afford the process of testing, traveling to get the surgery done and food and medicine for convalescing,” he explains. 

“There is a major need for assisting eye care health in Sri Lanka. Working with the Sri Lankan health authorities, National Eye Hospital and regional ophthalmologists, the UK charity ARR of which I am chairman of Trustees we respond whenever we get a request from a doctor for assisting the hospital with eyewear and related needs,” he explains. 

It costs Rs. 15,000 per person as a basic cost if these surgeries are done in State hospitals and the price is about a lakh if in a private practice. 

Speaking in Padaviya in a field coordinating visit by Dr. Sarveswaran to follow up on the beneficiaries of eye surgeries done in Jaffna teaching hospital previously (for Padaviya, Shri Padaviya and Welioya farming communities), Ven. Suguna Thero in the Shri Bodirukkarama Viharaya of Aliwanguwa in Shri Pura, Padaviya explained how the temple has been coordinating this assistance. 

Ven. Sugana Thero has coordinated with medical practitioner for Padaviya, Dr. H.M.D. Chathuranga and directs individual and institutionalised donor assistance that is often routed through the village temple.

“These people are farmers who struggle greatly with debt. They cannot afford the high costs that is required for private practice. Hence what is being done by these physicians and philanthropists such as Dr. Sarveswaran is a meritorious service to these arid villages which constantly suffers from drought which results in crop failure. We urge more people to be aware of these needs of these people in related to overall health and other needs,” he stated. 

“In 2022, Assist RR funded 2,199 free cataract surgeries using funds raised by Team Solihull (Solihull School Community in the UK). Inspired by Team Solihull’s successful cataract project, a philanthropist from Malaysia through Alaka Foundation came forward to fund free cataract surgeries in Sri Lanka from January 2023. Alaka Foundation to kick start this project provided USD50k to fund free surgeries. ARR funded 2045 free surgeries in 10 districts in Sri Lanka. 

Although it was estimated that around 1,750 surgeries would be covered it was finally possible to fund 2045 surgeries and thereafter another 5,054 surgeries up to end of May 2023 covering 20 districts supported by Alaka Foundation. In total 7,099 cataract surgeries have been facilitated at an overall cost of Rs. 58.5 million.

Dr. M. Malaravan and his team carried out 1882 of these surgeries for patients from Jaffna, Vavuniya, Mullaithivu and Mannar districts at the Jaffna Teaching Hospital. Colombo National Eye hospital had performed 1380 surgeries, Dr. Ayasmantha Peiris helped 837 patients at Ratnapura DGH, and Dr. Kasun Gunawardene carried out 615 surgeries at Chilaw DGH.

Buoyed by this success, which has changed the lives of so many for the good, Alaka Foundation had introduced another philanthropic entity (Ananda Foundation) from Malaysia, who has also come forward to fund more surgeries in Sri Lanka. To date more than ten thousand surgeries have been funded islandwide connected to the collective effort of the above mentioned initiatives. 

Using philanthropy as an unprecedented country-wide solution to prevent avoidable blindness for Sri Lanka’s poorest people – opens vistas for promoting stronger policymaking for equality in eye care health. This will spearhead the concept of private-public partnerships that assist the State health system in times of the current economic crisis. 

The underlying backdrop is that any national need can be used also to connect the nation and its people. As seen through the efforts of those such as Dr. Abeydeera and Dr. Malarawan, the mission of preventing blindness in low income groups is also aiding in the national reconciliation much needed in the country. 

In the weeks to come we will continue in the public awareness initiative of eye care needs of Sri Lanka.