Dr. Borah of Orbis India

As the Country Director for Orbis India, you would assume that Dr. Rishi Raj Borah has an origin story similar to that of many pre-eminent advocates leading the charge in the early diagnosis and treatment of childhood blindness; but Dr. Borah’ story is more a tale of action inspired by compassion.  Dr. Borah began his career as a veterinarian but had always wanted to engage with organizations that were associated with children. When he graduated, he had become very involved with the community volunteering organizations that would venture out in the evenings to find and help groups of children sleeping on the streets.  Often, as part of his work in these organizations, he would bring them blankets to endure the harsh weather, some food and hygiene kits. He would also sit with them and understand their stories. On one such evening, Dr. Borah found himself sitting peacefully with a child. He glanced just beyond the child to see a cow tenderly nestled in with her calf fast asleep by her side.  At that moment, it struck Dr. Borah that animals were capable of taking better care of their young than humans.  He dug his heels in deeper with his volunteer efforts with organizations that focused on outreach to children through various organizations, ultimately leading to his present position at Orbis India where he has been actively working for these past 14 years. 

Co-Founder of Know The Glow, Megan Webber, engaged Dr. Borah with background on the mission of KTG and in return Dr. Borah elaborated on the origins of Orbis.  The Orbis Flying Eye Hospital came into being in 1982 as an alliance between medicine and aviation. At the time they were the world’s first fully functional teaching eye hospital.  With this global capability, they were able to go into developing countries to bring awareness, education and training to healthcare providers in remote areas for screening and treatment.  Over the years, Orbis realized that while they continue training programs on-board the Flying Eye Hospital, they should begin in-country programs.  So, it was in 2000, Orbis began its journey in India.

Dr. Borah explained that when the office was first established in Delhi in 2000, with support of representatives from Government of India, WHO, IAPB and other leading eye care organizations in India, Orbis decided what its focus would be in the country.  They concluded that childhood blindness and corneal blindness need to be prioritized in India.  At that time, with a population of 1 billion, India needed 100 Children’s Eye Centers (CEC) as per the WHO recommendation of one center per 10 million population.  In 2002, the India Childhood Blindness Initiative (ICBI) was launched with the first Orbis supported Children’s Eye Center at Dr. Shroff’s Charity Eye Hospital in Delhi in 2004. Ever since, their network of CECs has grown to 33 Children’s Eye Centers across 17 states. During its initial years,  Orbis also supported the establishment of three Pediatric Ophthalmology Learning and Training Centers (POLTCs) in order to bring the concept of pediatric ophthalmology teams and pediatric ophthalmology as a distinct sub-speciality to the fore. 

While Dr. Borah is proud of the progress that has happened in such a relatively short period of time, he still has concerns about availability of adequate human resources to accommodate every child’s eye care needs.   Multiple healthcare providers or aides are often required to engage with each child and get them diagnosed early enough to reverse or correct any vision issues. Therefore, there is a great need to train  and create a robust pediatric ophthalmology team.  Under the India Childhood Blindness Initiative (ICBI), Orbis India’s flagship program, one year fellowships for pediatric ophthalmologists, six-month fellowships for optometrists as well as additional training for pediatric counselors and nurses are undertaken. Even in the rural setups, there is a great need to train the Anganwadi workers and the ASHA (who are primarily the immunization nurses) to recognize the problems early on in the targeted population of children 0-6 years of age.  This age group is largely missed since they are not school age where some vision screening is being done and if their vision impairment precludes them from participating in school, they are often not sent to school at all.

In fact, in 2016, Orbis started its REACH (Refractive Error Among Children) program to screen school children for any ocular problems including refractive error.  In just three years, they have been able to screen over 5 million children.

Yet, Dr. Borah explains, while Orbis India has been able to set the stage for better structure and treatment facilities, the bigger problem that the eye care community is facing across all of India is referral compliance.  Getting children to the tertiary centers is a challenge.  So what can we do?  Dr. Borah stresses the importance of creating awareness with the parents so that they can get the children properly diagnosed and treated.  Orbis India needs these effective communication tools for communities so that they can take up the issue of vision care at a very early age hence the need to help parents in rural areas understand how important it is to detect eye care problems. But how can you provide community messaging that will not scare families but instead make them take eye care more seriously?   

This is the gap where Megan and Dr. Borah would like to explore a potential collaboration between KTG and Orbis India.  There is a lack of effective communication materials to educate the families who are the most likely to notice a vision problem in these early years of development.  It goes without saying that if the community does not read the promotional materials then the education is without effect. Know The Glow has, at its core, a simple message and wonderful materials that could be utilized at the grassroots level where families can be educated in the early detection of vision problems. 

An eternal optimist, Dr. Borah likes to see that with every obstacle a new path can be created.  While the screening and outreach activities have been halted due to COVID-19, a better option has emerged—house-to-house screenings. When the schools are safely open again, screening will one again commence; however, there is not good spectacle compliance in the schools where children are screened because there is minimal parent contact. By the time the child returns home, the notice that the child needs spectacles is often not received.   But when  house screenings are conducted, health workers would immediately involve the parents in their child’s visual health.  The strategy is to reach out to the children in the home, which gives service providers the opportunity to provide vision screenings as well as creating awareness among families about vision care. Additionally, Dr. Borah sees great value in family screenings, which will allow healthcare workers to learn a lot more about the demographics. For example, if workers see multiple visual impairment cases in one family, they will be able to recognize any trends of similar eye problems within a family line or even a community. 

Megan and Dr. Borah look forward to continuing their conversation as they seek paths to collaborate in pursuit of their joint mission — helping to find children aged 0-6 years, and guide them to visual care, so they can see their way to a bright and beautiful future.

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