In 1984, Munir Ahmed, the current Country Director for Orbis Bangladesh, was looking for help with his own eyes when he came to Dhaka and met with the eye doctors of Orbis. The experience left an indelible mark on him and he immediately knew, both in his head and his heart, that he loved Orbis. It wasn’t the most direct path to his current position, but the knowledge and exposure he received along the way, working with the rural infrastructure and the needs of the people of Bangladesh, were invaluable. Megan Webber, Co-Founder of KnowTheGlow shared with Dr. Ahmed that while KTG is most urgently trying to find retinoblastoma patients we are also looking to find other glow-related conditions along the way. Dr. Ahmed, who truly is always in a state of gathering information, was very impressed with the awareness campaign and its ability to fill a void in screening, that of finding children aged 0 to 5.
Dr. Ahmed shared how, even as a young boy, he was always writing in his exams that he wanted to become a doctor. He grew up seeing how health issues could drain a family financially and he was equally inspired to make a difference in helping people find their way to quality care with less financial strife. When his father died, Dr. Ahmed found himself trying to determine “What should I do?” Should he be a clinician or serve the community where he would be able to treat a lot of patients at a time? He struggled with his decision and ultimately accepted a government position within the Ministry of Health and Family Welfare for three years. Posted in a remote rural village, he saw the lack of adequate training for healthcare workers and how the approach even from the medical professionals he encountered lacked compassion. During his first post as a school medical officer, Dr. Ahmed visited all the schools and wondered why services were not being properly provided? Was it a lack of specialists? Taking a look back at his childhood growing up outside of Dhaka, he realized that he grew up with vision issues while in school which was never recognized or diagnosed! It was then that he realized the problem was a lack of classroom intervention and that unless qualified healthcare professionals begin going to the children, they would never receive glasses or proper diagnosis.
His life journey led him on to posts as a health expert with the Bangladesh Rural Development Program, then with the Liverpool School of Tropical Medicine where he learned the value of prevention, not just treatment.
When returning to Bangladesh he worked with BRAC with the National Nutrition Program and then joined Save The Children to help guide the way for more publicly supported poverty reduction efforts. It was through this position that he was able to work with the Director of Save The Children to outline how to more effectively implement quality eye care into the primary care system.
Looking for an opportunity to continue to develop concrete programs that benefit the children while engaging with the government, Dr. Munir started with Orbis Bangladesh as their Country Director, ultimately bringing the Flying Eye Hospital ten times to his beloved country as of 2017 and trained eye health professionals and allied eye health personnel in Bangladesh both from government and NGO eye hospitals who participated to learn the upgraded skills, technology-based innovative, etc. in eye health. Initially the ground project was the most important program, and Dr. Ahmed wanted to work with the government to decide what they were doing specifically for children. With a pediatric Eye Care Center in Chittagong, they needed ready resources and trained personnel and to work to better identify the gaps and problems at the various facilities throughout Bangladesh. Dr. Ahmed’s goal was to have a National Eye Care Program up and running in Bangladesh. Dr. Ahmed explained to Megan that the cost of pediatric surgeries range typically from $200-$300 US dollars. In government hospitals the care is free but for the tertiary hospitals there is a fund that is available to pay for surgeries and there are NGOs with established pediatric eye care units. Ten percent of children need support from someone (NGO, Private donors, etc) but there are many generous philanthropies in Bangladesh and the people of Bangladesh are very sensitive to providing for the children,
Dr. Ahmed points out that we cannot forget refractive error in children. Over 1.3 million children need glasses and are unfortunately not receiving them. The school health programs are not identifying everyone and he fears that for much of the country not much has changed since his childhood. Squint is very common as well as eye injury and now ROP cases are emerging. There have been advances made, however! The new focus on proper detection and treatment of Retinopathy of Prematurity in Dhaka has led to proper care in the other surrounding hospitals as well. Dr. Ahmed advocated for proper vision care guidelines and today there are 14 pediatric Eye Care Centers (10 of them serving as advanced secondary hospitals capable of performing cataract surgeries, etc.) and it is no longer necessary to send patients to India for treatment. Patients can now be treated effectively within Bangladesh.
Orbis Bangladesh has partnered with UNICEF to provide screenings in eight centers and will be working to create a network of pediatric eye screening. He is optimistic that these screenings will be helpful as childhood blindness has become a recognized priority in Bangladesh. Dr. Ahmed stresses that screening is needed at the community level. Covid-19 has provided the opportunity to build up an army of Community Eye Care Workers (CECW) and to introduce a digital platform to go house to house screening children and creating a list of those who need eye care. They have started this “life history intervention tracking” pilot program to keep track of these children so they can be follow-up with them and their families. They have also introduced a module training eye program on the computer to document and track information and care. Dr. Ahmed said that in the past they had relied on vision camp screenings but they were not that effective. It is better to identify, document, and proactively screen a cluster of children and then refer those needing more intervention to an eye care center. They have introduced digital appointments and hope to soon have teleconsultation appointments as well as a hotline so that people can reach out to vision care specialists. Dr. Ahmed hopes to make use of Cybersight, Orbis’ online training resource, for consultations in addition to its use in training optometric personnel.
Megan was thrilled to learn how Orbis and BRAC are engaging and empowering women at the village level. They are doing an incredible job with CECW recognizing the invaluable role of women who bring with them great compassion surrounding their work with children. There is still so much work to be done in Bangladesh but with Dr. Ahmed and Orbis Bangladesh, the wheels are in motion, and extraordinary progress is being made. Bangladesh is fortunate to have a native son, Dr. Munir Ahmed, so well versed in the unique challenges and incredible opportunities that abound in his country. He continues to work to fulfill his lifelong desire to be one with Orbis and to bring end-to-end vision care to the children of Bangladesh.
