Doorstep delivery

I have received an early Christmas present.

It arrived on my doorstep in London. A brown cardboard box full of : small black rectangular objects with coloured segments on one side and tiny kingfishers on the back, glistening white ribbons, neat black pouches, silky pieces of cloth covered with lettering, USB chargers and 30 funky little plastic monsters.

I interrupted my last-minute funding applications and my packing for India to play with the contents, a big smile on my face.

Fiddling around with a bunch of toys when you should be consolidating funding sources and finalizing your itinerary to rural Bihar?? Frivolous woman.

Not so. Packaged together, these individual items make up easily the most useful method of ophthalmic examination for teams working in remote areas of the world. The rectangular objects are arclights - pocket-sized, solar-powered ophthalmoscopes with additional attachments to be used as otoscopes (for examination of the ear). The ribbons enable them to be hung around necks, the USB chargers in case there is insufficient sunlight (not often a problem in India), the piece of cloth is actually a vision chart and the plastic monsters…well, I have to work that one out.

Our rural ophthalmic teams in Bihar have been using the arclight for years. Optometrist and inventor William Williams designed it, egged on by global ophthalmologist John Sandford Smith. John had identified a great need for a cheap, light, robust ophthalmoscope to examine the eye – front to back, cornea to retina -  in rural settings in developing countries. The heavy battery powered instrument we use in British and most Indian city hospitals is not suitable technology for rural ophthalmology. (The full delightful tale of Williams’ early experiments can be read in my second book – Outgrowing the Big).

These archlights are now sold in the UK and are used by general practitioners and medical students. However, William gave me the first batch to try out in the field in Bihar some years back. Bihari ophthalmic assistants and doctors were very taken with it and William presumably delighted that the invention was in use so quickly. So now William’s brother Roy kindly delivers supplies of each improved model to my doorstep. This time, with perfect timing.

In a few days’ time I will be in villages in Bihar, chickens clucking around my heels, buffaloes lowing and oh dear, yes, the 24/7 barrage of music (it is the Marriage Season again). It is also the busiest season for all the eye hospitals. So outreach workers will be setting up their screening camps every day. We will use darkened huts or corners of temples and classrooms for arclight examination. We will leave them in the winter sunshine to recharge. If we forget them we can be sure that some helpful village volunteer will come running after us.

The boys and girls using the arclights will be largely ophthalmic assistants. This job description is, I think, unique to India. Young men and women are trained to do all kinds of ophthalmology – from diagnosis and treatment of primary eye diseases, to giving anaesthetic injections to surgical patients, refracting patients to see if they require glasses and assisting eye surgeons in the operating theatre. These multi-purpose workers have a hugely enjoyable and varied job. And most seem to be naturals when it comes to explaining diagnoses and treatment to frightened and illiterate patients. Many of them come from the communities their hospitals serve.
Hardly surprising that the multi-purpose arclight is now proving to be the weapon of choice for the multi-purpose Indian ophthalmic assistant.

‘ Truly this is the best equipment for me,’ I was told by a young man called Umesh. Part of the DSN hospital team in northernmost Bihar, he carries out screening camps in a tiger reserve …being able to relocate rapidly with light, portable equipment is an obvious advantage!

So I want to Big Up the multi-skilled, multi-talented ophthalmic assistant in India. And to thank William Williams for the arclights. One will be dangling around my neck for the entirety of my trip to rural Bihar. Apart from its practical use, I think of it as a kind of talisman cum comfort object, a symbol reminding me that throughout our now quite extensive work it has been small, suitable interventions and good people that have enabled the blind to see.

Wish me a safe journey, dear readers, by clicking the LIKE button below this posting. I will be without reliable internet access for much of the next six weeks. It will be nice, once I am back, to see that some people have read my writing in homage to the arclight and in praise of the ophthalmic assistant.

Lucy Mathen

#arclight   #suitabletechnology  #williamwilliams #multipurposeophthalmicassistant