In early March I visited the city of Hyderabad, thereby marking my first time to the newly formed state of Telangana which had been recently carved out of its now neighbouring region of Andhra Pradesh. The visit was targeted at monitoring a project in which the Partner, LV Prasad (LVP) is a leading institute in the provision of quality and affordable eye health services. It may seem a secondary developmental issue upon first glance however the rate of cataracts, low vision and visual impairments in rural India remains strikingly high. According to the World Health Organisation (WHO) the leading causes of visual impairments globally are uncorrected refractive errors, unoperated cataracts and glaucoma. All 3 of these factors being preventable conditions and therefore in which the drive towards eliminating avoidable blindness is centred upon.
While speaking with the hospital staff at LVP I began to understand that the main reasons why these impairments are worsened in patients over time is their refusal to be screened and treated. It sounded like an unfathomable equation to me, I mean if as an individual your journey towards blindness could be prevented why wouldn’t you present for treatment? The answers to this are as complicated as they are deeply entrenched by which gendered dynamics, socio-economic restraints and tribal beliefs present as impediments towards good health and well-being.
I was further surprised to hear that these situations were not simply isolated to more rural and remote contexts but were also to be found in patients from middle income urban dwelling families. The case of a young woman in her 20’s was identified whereby she was diagnosed with low vision and was prescribed with glasses. It came to light that years later her vision had decreased and when questioned as to why this was the case her parents had explained that they had rejected the practice of this young woman wearing her glasses as they felt it would limit her marriage options. Thereby meaning that due to socially constructed ideas of stigma associated with compromising of ‘female beauty’, this woman’s health was being drastically compromised.
The situation seemed to intensify as we travelled out into more rural locations in Telangana where the intersectionality between gender, disability and ethnicity, in this case tribal beliefs make the pursuit of quality healthcare for women even more of a difficult endeavour.
The Kollapur Vision Centre is located around 3 hours south of Hyderabad towards the Karnataka border. Within this region the presence of tribal populations is quite high and therefore the fear of any kind of surgery usually inhibits people from the promotion of their well-being. When speaking with those who were waiting to be screened the barriers towards uptake of quality services began to come to light. The villagers present spoke of the logistical challenges associated with travelling to the centre and the time spent away from their vocations. This is even more pronounced when you begin to understand that most are day labourers and therefore will need to forfeit a day’s pay in order to access services. For women, there are questions around who will take care of their children whilst they are away. Most also explained that what little free funds they have outside fulfilling their basic needs are usually allocated to the promotion of their husbands health care and well being.
For LVP’s part they have worked extremely hard to mitigate against these barriers of access. Appointing locally sourced vision guardians has meant that fears have been quelled by trusted members of communities. The fact that most of these guardians are women has also addressed the gendered barriers of the uptake of services focusing on awareness raising for families so they understand that healthcare is a basic human right for all. The provision of transport to and from vision centres has also assisted with reducing the burden of cost for patients. In addition to this, LVP have a tiered system for payment whereby those who are able to contribute, provide what they can however around 70% of patients in rural locations are provided with free services and surgeries.
With all this in mind the difficulties around the prevention of avoidable impairments in this context remain. However, as the project takes hold and awareness is raised, the health seeking behaviour of communities is bound to change for the better.