Mobile eye hospital

A mobile hospital on a train can provide medical services in remote, inaccessible areas, Sunil Jain MD, Indira Gandhi Eye Hospital And Research Centre, Lucknow, India, told delegates at the XXXIV Congress of the ESCRS in Copenhagen, Denmark. “The Lifeline Express, the world’s first hospital on a train, is helping us reduce the huge backlog of treatable cataract blindness across India,” he told a session dedicated to Orbis. The train was launched by the Impact India Foundation. Dr Jain shared the results of his team’s extensive experience on the Lifeline Express, which has performed over 75,000 cataract surgeries since 1991. RURAL AREAS “The purpose of the mobile hospital is to provide on-the-spot, curative surgical treatment free of cost to the disabled poor in rural India, by utilising the entire Indian railway network. As disabled and poor people in rural areas cannot reach a hospital, the hospital should reach them,” he said. The train consists of five coaches, each of which has a specific function. There is a generator, a steriliser, two operating theatres and an auditorium coach, reserved for conferences and teaching moments. Patients are screened by a medical officer and intraocular lens (IOL) power is calculated preoperatively by optometrists. Postoperative steroid, antibiotic and cycloplegic drops are started the next day. “We perform small-incision cataract surgery with IOL implantation, after which the patients are moved to the postoperative ward,” said Dr Jain. Surgery is performed inside the train itself, with the outpatient department and postoperative ward set up outside the train at scheduled stop locations. Each stop lasts for three to four weeks, during which approximately 600 cataract surgeries are performed. The train is shared with several other subspecialties, covering orthopaedics, ear nose and throat pathology, plastic surgery, dental services, and health education and women’s health specialists. COLLABORATIVE EFFORTS Several administrative tasks must be performed prior to the arrival of the train. These include selection and preparation of the local project site, including receiving permission from local authorities, and generating publicity and awareness via the media. This preparation requires the collaborative efforts of the government, voluntary agencies, voluntary medical and paramedical professionals, sponsorship organisations and the Indian railways. The ‘mobile hospital on a train’ concept has since been replicated, with four Lifeline Express trains in China, two in South Africa, as well as riverboat hospitals in Bangladesh and Cambodia. It provides a model for the many nations where a similar need for medical care in hard-to-reach places exists.