joint programme – cataract surgery for underprivileged ... · during each surgery sessions,...

Pro

ject

Pre

senta

tion

Joint Programme – Cataract surgery for

underprivileged patients in Morocco

Fondation Althea Restoring sight for a better life

www.fondation-althea.org 2

Background

In Morocco, an estimated 1'500'0001 people suffer from cataract. A large part of this people live

are underprivileged and live in rural or nomadic areas, with no or little access to medical care.

Only in the province of Rhamna, the number of cataract patients is approx. 4'ooo. Most of them

can just not afford the costs of treatment.

Today, cataract is still one of the major

causes of strong visual impairment or total

blindness worldwide, amounting to 51% of

global causes. Persons affected dramatically

loose in quality of life, are impaired in their

mobility and their daily professional or

private activities and often become a burden

for their family or community. This doesn’t

need to be! Cataract is mostly a curable

disease, with a simple surgery operation to

replace the clouded lens by an artificial intra-

ocular lens. The patient sight is then

restored, and therewith her or his abilities.

To tackle this huge challenge, the Ministry of

Health, Foundation Althea, Dr. Mohamed Chabhi and Alcon have decided to team-up and carry

out eye surgery campaigns. This action is along the objectives of the campaign “Vision 2020 –

The Right to Sight”. The aim is to make priority target regions “a Cataract free zone”. Once

achieved, this would mean that only new cases would then have to be operated

At the Ministry of Health, Dr. Jaouad Hammou is the coordinator of the National Programme for

Prevention of Blindness. Since he took office, he is putting great efforts and mobilizes all

possible resources to tackle the huge challenge posed by visual impairment and blindness in the

country. He was key to facilitate missions by Fondation Althea and other actors and is an

important support to our actions. The task facing him and his teams is rather tremendous, so he

welcomes and supports all relevant initiatives that may contribute to improving the situation and

people’s lives.

Dr. Chabhi is a reputed ophthalmologist. Beside his work in his profitable eye hospital, he

dedicates himself since many years to cure underprivileged patients, who otherwise would

irremediably remain blind. He built up a team of equally dedicated and professional assistants

and nurses who assist him in this remarkable and charitable action.

Elimination of blindness through cataract surgery campaigns in rural areas of Morocco

represented the focus of Fondation Althea since the beginning, and several successful missions

were carried out from 2002 till 2009. Due to constraints in finding volunteer ophthalmologists,

and with important needs in schools for vision correction, we temporarily turned our efforts on

optical campaigns only, for providing children with eye-glasses and medical treatment when

needed. Today we are happy, with the support of MoH and Dr. Chabhi, to also resume our actions

to prevent avoidable blindness, thanks to the commitment of Alcon. Moreover, this is in line with

our long term goal, to have local ophthalmologists and teams, occasionally supported by foreign

1 source: World Bank


ophthalmologists, to secure surgery and specialized care all along the year. It fulfills the needs of

proximity, thorough post-op follow-up and permanently available services.

Planned action

Health services in Moroccan provinces carry out surveys in rural and poor urban areas in order to

identify operable cataract patients who are matching the criteria for free surgery.

Considering the total number found in Rhamna region, say 3'688 and the fact that this is one of

the most densely populated rural areas, we plan to carry out sight restoring surgeries in priority

there. Dr Chabhi and team have the capacity to operate, using the phaco-emulsification

technology, about 1’000 patients per year.

We plan to begin with a first group of 200 patients from the Rhamna area, a very populated

region with a substantial number of poor patients. To work more efficiently and as the travel

distance is relatively short (250 km), patients

will be carried by buses to Dr. Chabhi clinic,

undergo lab tests and pre-op examination.

Patients with glaucoma or diabetes type II, or

those having retina diseases who would

make a cataract operation meaningless, will

be excluded. Those with operable cataract

will undergo surgery with IOL implantation

and have post operative care there.

Afterwards all patients will be brought back

to their place of residence.

Dr. Chabhi on outreach mission in Senegal

For those with various eye problems, options will be discussed with the MoH in order to find

ways for treatment. Glaucoma patients e.g. may be operated or receive treatment, and could be

eligible for cataract surgery at a later stage. Patients with bilateral cataract will be operated in

one eye, then the second eye few months later.

Depending on patients location, further campaigns will either be organized the same way, or

Dr. Chabhi and team would travel to hospital facilities closer to patients living area, in outreach

missions.

During each surgery sessions, statistics will be made, recording the number of patients for each

ailment, number who underwent cataract surgery, and patients who received other treatment or

referred for treatment. Surveys are ongoing, therefore more patients will be progressively

assessed, and lists established for future surgery sessions.

Our common action contributes to the objectives of the WHO « Plan of action for the prevention

of blindness and avoidable visual impairments 2009 – 2013, in particular :

� Obj. 2. Elaborate national policies, plans and programmes for eye health and prevention

of blindness, or reinforce the existing ones

� Obj. 4. Improve coordination between partners and actors at national and international

levels to prevent blindness and visual impairments


This first campaign will take place in the second quarter of 2013. Dr. Chabhi welcomes Alcon

management and co-workers in Morocco to attend the eye-surgery sessions as wished.

Contribution from the various partners

The Ministry of Health provides services through its local teams for screening and preparing

patients lists, and support to the surgery team when in outreach campaigns. They will also check

and ensure that only indigent patients will get access to free surgery.

The MoH also provides vehicles, fuel, local accommodation and subsistence for outreach teams

Fondation Althea provides logistical and organizational support to shuttle patients from their

place or residence and back. We would also contribute in finding solutions and partners to make

suggestions to the MoH for treatment of other eye patients. We provide expertise and formats for

statistics, and ensure those are delivered to the relevant bodies and partners. We would also

coordinate with Alcon and regularly report on progresses.

Both partners, with the support and involvement of Dr. Chabhi, will seek motivated and

competent Moroccan ophthalmologists to take part in such outreach campaigns, in all relevant

provinces and areas. When required, additional training will be organized at reputed professional

facilities.

Mr. Tlemcani, owner of a medical laboratory, has generously volunteered to perform all necessary

lab tests at his facility, free of charge.

Support required from Alcon

For the global surgery campaign, Dr. Chabhi would need an Alcon phaco-emulsification unit

Four (4) handpiece, and a reasonable number of consumables therefore. This type is more

appropriate both for performance and as it limits the number of necessary consumables. Possibly,

he will use his own phaco-unit for this first campaign, but would need the necessary

consumables.

We would also require the appropriate number of IOL, visco-elastic fluid and relevant surgery

consumables, as well as eye drops for pre-op and post-op care. A list with the required diopters

provided to Althea by Dr. Chabhi and is attached (Appendix II).

After the initial campaign and once the first approximately 200 patients are operated, we will

provide statistics and apply for the next batch of IOLs and supplies. This way, we ensure that

appropriate reporting is provided. As we will ourselves require pictures and a short narrative

report, this material can also be provided to Alcon for use in its publications.

One has to note that Dr. Chabhi, with a very long experience, has developed a technique to also

operate mature cataracts using phaco-emulsification. This equipment may not be usable for that

purpose by other ophthalmologists, unless previously trained by him. Other ophthalmologists

may used other techniques they master better, such as the small-incision surgery.

We would also appreciate Alcon support in identifying experienced ophthalmologists in

Switzerland, the EU or USA, willing to voluntarily contribute by participating in outreach

campaigns aside their Moroccan counterparts.


Further steps

Once campaigns are well established and running, and when all partners are satisfied with the

cooperation and results, therefore establishing as strong mutual partnership, we may further

develop the programme.

Together with the MoH and Dr. Chabhi, we will prepare a multi-year action plan, including

information on the incidence of cataract in the least privileged regions, resources available in

terms of specialized manpower, and planning of campaigns.

Our common goals are ambitious, but the needs are huge, and with the contribution of very

motivated partners, we can certainly make important progress in helping the least privileged

Moroccans to regain sight and autonomy, and certainly more happiness.

Appendix IV give details of the response to cataract surgery needs in Morocco in the past 20

years.

Making one region “a Cataract free zone” would be in itself quite a tremendous achievement, and

a notable contribution to the goals of Vision 2020.

We are all deeply grateful to Alcon for being a part of the response to this important challenge

and sides with us in favor of the most underprivileged women, men and children of Morocco.

Pully, 22.03.2013

Nezha Drissi

Présidente

Fondation Althea

Contact persons

Nezha Drissi

President

Mobile. 079 607 79 62

E-mail: [email protected]

Jacques Renk

Member – Project Advisor

Mobile 079 256 54 11

E-mail: [email protected]


Appendix I

First campaign facts and planning

Tentative 2013 campaigns planning Jointly with the Ministry of Health and Dr. Chabhi, we will discuss the feasible timing for following campaigns and provide Alcon with the relevant planning and list of needs.

Region Population

Estimated Nr. of

cataract patients

(prevalence)

Cataract

prevalence

in %

Nr. of screened

cataract patients

(to date)

Dates of

surgery

campaigns

Morocc o 16 463 634 2.10%

Rhamna province 288 437 26-27.01.2013

C ataract surgery campaigns - Information on regions and needs


Appendix II

List of IOLs with diopters and cassettes for the phaco-unit

Diopters Units

Cassettes,

units

6.0 1

7.0 2

8.0 2

13.0 2

16.0 3

18.0 4

20.0 89

21.0 89

22.0 4

23.0 4 40

Total 200 40

IOL and cassettes needs for Cataract Surgery

Campaign by Dr. Chabhi in Rhamna

1 cassette suffices for 5 patients


Appendix III

Statistics format

Pays : Maroc Région : ..........................................................

Période du .................................. au ...................................

Ophthalmologie

Nombre total de consultations Consultations effectuées

hors de l’hôpital de base à l’hôpital de base

Patients de cataracte

Patients de trachome

Patients de glaucome

Patients d’onchocercose

Patients d’onchocercose traités á l’ivermectine

Patients de trachome traités à l’azithromycine ou tétracycline

Patients xérophtalmiques

Patients souffrant d’affections oculaires en rapport avec la lèpre

Réfractions (adultes)

Réfractions (enfants 0-15 ans)

Patients/bébés de rétinopathie des prématurés (ROP)

Patients souffrant d’autres affections oculaires

Nombre total d’opérations Opérations des yeux effectuées dans votre projet

hors de l’hôpital de base à l’hôpital de base

Extractions de cataracte avec implants (IOL) (adultes)

Extractions de cataracte avec implants (IOL) (enfants 0-15 ans)

Opérations de glaucome

Opérations de trachome

Opérations de rétinopathie des prématurés (ROP)

Autres opérations des yeux majeures

Autres opérations des yeux mineures

Nombre total de lits d’hospitalisation disponibles pour patients ophtalmiques à l’hôpital de base

Cliniques mobiles (services mobiles) Nombre total

Par ophtalmologues

Par auxiliaires ophtalmologiques (équipe d’assistance)

Nombre de patients au dehors soignés à l´extérieur, enfants (0-15 ans)

Nombre de patients au dehors soignés à l´extérieur, adultes (+15 ans)


Appendix IV

Evolution de la prise en charge des cas de cataracte au Maroc

Evolution du taux chirurgical de la cataracte par million d’habitants par année


Evolution du nombre de campagnes de chirurgie de la cataracte

Nombre de bénéficiaires des campagnes de chirurgie de cataracte


Données démographiques de la province d’Erhamna

Région de MARRAKECH TENSIFT AL HAOUZ2

I – Population cible :

1) Population totale : 309.000

2) Population par commune :

Formation sanitaire Commune Population Incidence de la

cataracte, cas recensés

Benguerir 72.217 72

Brikyenne 14.133 196

Sidi Ali Labrahla 4.483 23 C/S BENGUERIR

Od Hassoune Hamri 7.645 334

Skhour Rhamna 15.380 46

Jaafra 10.748 233

Sidi Abdellah 10.874 47

Sidi Mansour 6.752 145

Sidi Ghanem 12.981 90

C/S SKHOUR

Skoura Lhadra 9.556 107

Ras El Ain 13.809 130

Akarma 6.049 47

Tlauh 10.586 227 C/S RAS EL AIN

Jaaidate 11.765 52

Sidi Bouathmane 18.741 361

Nzalet Laadem 15.655 43

Sidi Boubker 6.837 158 C/S SIDI BOUATHMANE

Bourrous 6.141 39

Bouchane 10.213 262

Od Amer Tizmarine 5.752 22

Aît Taleb 9.500 433 C/S BOUCHANE

Aît Hammou 8.014 19

Lamharra 10.868 587 C/S MHARRA

Od Imloul 10.301 18

Population totale / Number of patients to operate 309.000 3.688

II – Indicateurs socio-économiques :

1) Taux de pauvreté : 28,47 %

2) Taux d’analphabétisme : 59 % (moyenne nationale 43,1 %)

3) Taux de population active : 34 % (moyenne nationale 36 %)

4) Taux de vulnérabilité : 32,34 %

2 Source: Ministry of Health of Morocco

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