One shocking statistic stands out clearly from our research: if the current rate of cataract operations were to continue, it would take 159 years to clear the current backlog of adults visually impaired by cataracts.
The Neglect of Surgical Care of Cataracts in the Al-Najaf Governorate, Iraq - 2005/6
Al-Hakim HAW1, Hassan HMJ2, Shookur Z3, Cudd PA4
1 – Dept. of Ophthalmology, University College Hospital, London NW1 2QG, UK (email@example.com); 2 – Dept. of Ophthalmology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK (firstname.lastname@example.org); 3 – Medical College, Kufa University, Al-Najaf, Iraq; 4 – Dept. of Medical Physics & Clinical Engineering, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK
PURPOSE: to initiate an exploration of issues that are influencing the healthcare of patients with cataracts in Al-Najaf Governorate, Iraq.
BACKGROUND : there is local awareness of a relatively high prevalence of people with cataracts in Al-Najaf, Iraq. Year on year the prevalence of people with cataract visual impairment is increasing. Primary causes suggested were due to desert environmental factors. It is also observed that the availability and organisation of acute healthcare in Al-Najaf and in Iraq in general is poor.
APPROACH : to collect information on healthcare service, social, political and economic factors that help to describe the healthcare scenario in Al-Najaf. To collect incidence data in Al-Najaf to contrast with estimated incidence and prevalence in the Middle East.
FINDINGS : For healthcare investment per capita Iraq invests drastically less than any of its neighbours. Acute healthcare services suffer from : severely restricted and poorly maintained facilities; insufficient staffing; inadequate staff training; and committed staff are therefore restricted in the number and type of operations they can offer. An unusually high prevalence of cataracts in Al-Najaf has been observed. Projections of cataract prevalence over 50 years in Al-Najaf are presented for various models of treatment and resources required.
CONCLUSIONS: The inadequacy of care provision seems to be the likely biggest cause of the current high prevalence of cataracts. Without significant changes (i.e. in investment and working practices) from the current status-quo large numbers of patients’ will suffer vision impairment unnecessarily. Further study is recommended to establish if there are other significant causes of the high prevalence of cataracts present that may be shared with neighbouring countries. The latter studies should include non-medical factors.
The facts are startling: 90% of healthcare in Iraq is provided by private hospitals and clinics, whilst 70% of the population is unemployed. Thousands have been displaced from their homes. Malnourished and subsisting on meagre food supplies from charities, many Iraqi families find healthcare a luxury they can ill afford.
Regarding ophthalmic care in particular, the situation is even worse: medical facilities and treatment centres are devastated from years of neglect, with much of the equipment outdated and barely functioning. Surgeons lack skills training and are demoralised from years of working under these conditions.