As evening prayers finish and the day’s fast is broken on the 7th day of Ramadan, Dr. Enayet Hussain graciously sat down to speak with Megan Webber, Co-Founder of KnowTheGlow, to discuss Dr. Hussain’s selfless work in Bangladesh and the enormous impact he has made in bringing awareness to childhood blindness there. Born in the eastern region of Bangladesh, in Sylhet, Dr. Hussain’s path to becoming a pediatric ophthalmologist began with fellowships that took him to the UK and India, but he ultimately came back to serve his homeland of Bangladesh to become a clinician and later a program manager in Dhaka. He told Megan that when he first came back to Dhaka as a clinician, he found himself to be one of only three pediatric ophthalmologists in the entire country. Now there are 85 pediatric ophthalmologists in Bangladesh. In his early days as a clinician, he believed that all patients should come to him. Over the years and through his experiences in the public sector he now sees that this perspective is flawed and that it is equally important and quite necessary to go into the communities and bring care directly to the people. Dr. Hussain expressed to Megan that there needs to be engagement with the community in a way that absorbs the community so that you have effective outcomes that lead to saving sight in children.
Fast forward to today, Dr. Hussain is the current Directorate General of Medical Education (DGME), under the Ministry of Health & Family Welfare. Surprisingly, much of what Dr. Husain promotes today can be traced back to his experience working as the Director of Non-communicable Diseases in the public health sector. “Eyecare should be a multisector area.” He explained to Megan that he found many of his ideas for policy-making issues and advocacy ideas while he was working in this sector. The Ministry of Child Affairs, the Ministry of Local Government, and the Ministry of Education should all be integrated and work together to increase awareness. Even school teachers should be involved at the community level. Ideally, there should be a pilot program created and implemented in a given area engaging all of these health and non-health sectors. Following a review of the outcomes, the program could be scaled up once successfully implemented.
Dr. Hussain expressed to Megan that it is regrettable that eye care is not included in the WHO’s Integrated Management of Childhood Illness (IMCI) module. He was very familiar with Dr. Clare Gilbert’s work (https://knowtheglow.org/raising-awareness-2/) in trying to advocate for the inclusion of eye care. Like Dr. Gilbert in Tanzania, Dr. Hussain said that he and his group of advocates took the initiative and after many discussions, they were able to incorporate eye care into the IMCI program in Bangladesh. Currently, they have developed a manual and questionnaires that are being utilized at the Upazila Health Complex, and health service providers are trying to examine babies as they come in.
The rural areas remain his largest concern. There is not equal access to health care when a baby is born and there are studies that show that those who are educated have more access to eye care. While there is an assumption that those in the urban areas will know to get their children to the health care centers, even in the cities, there needs to be more focus on prevention. The primary health care provider should be encouraged to screen the child’s eye reflex during the time of immunization at younger ages so that diagnoses can be made earlier and children can then be given the proper referral. According to Dr. Hussain, “child cannot complain and mother cannot understand earlier, delay diagnosis & intervention sight cannot be restored properly.”
It was after a 2003 Sightsavers Childhood Blindness campaign brought their program to Bangladesh that things began to dramatically change. Starting first with Vitamin A deficiencies and then moving to pediatric cataracts, the Sightsavers campaign created momentum in tackling the problem of preventable blindness in their society. Dr. Hussain said during this time, they performed more than 27,000 cataract surgeries of which 20,000 were bilateral.
Megan asked Dr. Hussain about their next success in reducing the incidence of Retinopathy of Prematurity (ROP). To catch ROP early, you need to have good neo-natal care. In the beginning, Dr. Hussain noted that 90% of mothers brought their babies to the initial visit but then the numbers quickly dwindled to 50-60%. Another strategy they implemented was to work with gynecologists educating them on the benefits of delaying delivery to 32 weeks or later so that ROP could be avoided altogether. With ROP they have integrated this relationship into the Government’s Maternal and Child Health Program and it is proving to be sustainable.
In the aftermath of the Covid-19, they have begun to shift from vision camps and are moving toward smaller, more precise person-to-person contact. Currently, they use community health care workers to go into the villages and organize a visit to one house and invite others from the village to come to them. Currently, the focus is on infectious diseases but the same program could be utilized for immunization and eye care. Megan agreed with Dr. Husain that finding ways to get to these children was vital. “We need ways to reach the unreachable,” she lamented. Dr. Hussain was optimistic about the future of eye care. He told Megan that the childhood immunization program has a rate of 91% accessibility. He told Megan that there needs to be a push to look into the eyes of these babies and young children when they come to get their immunizations. He is encouraging this approach as it is cost-effective to integrate into the eye care program as they would have a better chance of finding children with white reflex. Dr. Hussain truly believes that you cannot cast a net too wide; even suggesting that they engage local leaders in the communities as well as involving the mosque and other religious leaders. Building trust and increasing access to help raise awareness and vision literacy is key. There is still much work to be done but with Dr. Hussain leading the charge, there is much light shining on avoidable childhood blindness. The children of Bangladesh are in excellent hands as he continues to increase all the avenues to greater awareness and bring more children to care. Thank you, Dr. Hussain, for your tireless work and advocacy for pediatric eye care! We believe that Bangladesh is poised to make a huge impact on preventing childhood blindness thanks to his efforts and the efforts of the amazing organizations and individuals working with him!
