Community Outreach Screening Camps Procedures
Lions SightFirst Eye Hospital is famous for its community outreach programmes which provide different strategies for taking eye care services to the doorstep of the community. Through free eye camps, medical teams from the hospital reach patients in rural areas within a radius of 250 kilometers from Nairobi
Two regular camps are conducted every Monday, Thursday and some booster camps in between.
The teams work closely with local community leaders and service groups to organize the camps. Once the site has been agreed on, publicity is done by use of appropriate means which include radio announcements in the local languages, posters, announcements in the churches and local administrators.
The camp team, composed of an Ophthalmic Clinical Officer, 2 nurses, an optometrist, a driver and a clerk, leaves the hospital early in the morning to designated camp sites using the hospital vans. On the way, they stop at the various venues to give materials for publicity of the forthcoming camps.
B. At the Camp Site
Step 1: Pre-counseling
Every camp starts with a prayer followed by introduction of the team by one staff from the hospital. The staff then explains the procedure to be followed for easier running and management of the camp. Those present are then counseled on the services rendered including cataract surgeries. Before the screening, one post operated patient is given a chance to address those present so as to assure them of the success of the operations and also to instill confidence to those who will be selected for operations.
Step 2: Patient registration
With support from camp sponsors and local volunteers where possible, the team records the patient details - name, age and address on a card that the OCO will write diagnosis of the patient and for future follow-up.
Step 3: Preliminary vision testing
Preliminary vision testing is performed by ophthalmic assistants. Vision charts, such as the Snellen and E-type charts, are used. For those with severe vision impairments, hand movements are used.
Step 4: Preliminary diagnostic examination
The OCO performs the preliminary examination. Clinical conditions such as external eye infections, vision loss caused by nutritional deficiency and the incurably blind are examined.
Step 5: Tension and duct examination
Patients above the age of 40 have their intraocular pressure tested. A nurse administer topical anesthetic drops and measure the intraocular pressure with a Schiotz tonometer.
Step 6: Refraction
Refraction is performed on patients who exhibit refractive errors, presbyopia and those using outdated glasses.
Step 7: Final examination
The OCOs evaluates the test findings, perform the final examination, review the patient records, make the final diagnoses and prescribe treatment.
Step 8: Counseling
Patients advised for surgery are motivated by the counsellor to undergo surgery at the hospital. Relatives are then advised on post operative care when patients return back home. They are also advised to bring patients back to the camp site for review and post operative medication after 30 and 60 days. General counseling is given to the other patients not needing cataract surgeries.
Step 9: Optical Services
The OCO may also advice patients to wear glasses. Depending on the prescription, patients may purchase ready-made spectacles (readers), if available at the camp site. Refraction is also done and for those patients requiring low prescription glasses, they pay a deposit and the gallses are bade and brought in the next camp as they clear the balance. Otherwise, the patients are referred to the Optical Shop at the hospital where there is a wide selection of frames and lenses.
Step 10: Transport of Selected Patients
All patients selected for operations are booked in a register which is used at the hospital for admission. They are transported back to the hospital using the hospital vans and hired transport if the number cannot be accommodated by the hospital in the hospital vans. Those patients who are mono eyed or have physical disabilities are allowed to bring in a relative but the relative pays for his or her own transport to and from the hospital.
C. At the Hospital
Step 1: Admission and Accommodation
On arrival at the hospital, patients are admitted, given free meals and accommodation for 3 days and discharged on the 4th day unless if the doctors request that they are retained for further examinations or observations. There are separate male and female wards which can accommodate up to 31 men and 32 female patients at a go.
Step 2: Operations
Those patients brought in on Saturdays and Mondays are operated on Tuesdays while those screened on Thursdays are operated on Fridays. There are then given free medication for three days, discharged on the fourth day and transported back to where they were picked from.
Those patients not be operated for reasons like high BP, sugars or IOPs are put on medications and observed for 3 days. If their conditions have improved, surgery is done on the 4th day and discharged on the 3rd day after surgery. If in the 4 days their condition had not improved, they are discharged and advised to follow up with their regular physician until their health problems are controlled then they can come for the surgery.
Step 3: Post-Operative Care
On discharge, the patients are given medication to last 30 days until the next review at the camp site. They are then reviewed again after 60 days from the day of the operations.
D: Walk in Patients
Some walk in patients might converted into FOC patients which means that they will be treated as camp patients as far as surgery and accommodation is concerned but will have to pay for their fare back home after surgery.
These patients can only be given FOC treatment after the Ophthalmologist who has consulted them recommends that they be given free treatment and refers them to the General Managers office to seek the approval of the BOM Chairman. Unless the surgery to be done is an emergency, the patient will be booked for the next available day to avoid overstretching the wards and the theatres.
E: ORP and Base Hospital Communications
To ensure effective running of the camps, the following should be observed.
- The OCOs should liase with the sister in charge to know the number of walk-ins and retained patients in the hospital so that they can know how many patients to bring.
- The OCOs in the respective camps should give the nurse booking the patients for surgeries the number of patients that should be booked on that day.
- The OCO should then communicate this number to the sister in charge pointing out the number of special cases like the diabetics, children and mono eyes.
- The sister in charge then communicates this information to the kitchen and the accounts office.