Read ANNUAL ACTIVITY REPORTS text version

ANNUAL ACTIVITY REPORT

Pakistan Institute of Community Ophthalmology

2009

Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar P.O Box, 125, GPO. Peshawar Tel. +92 91 9217377 ­ 80 Web. www.pico.org.pk

Annual Project Report MPH in Community Ophthalmology (PICO) 2009 1. Project Background The Master Degree Course in Community Eye Health was started in 1998. The course is run in close collaboration with International Centre for Eye Health (ICEH) London, and London School of Hygiene and Tropical Medicine (LSHTM). It is affiliated with the Khyber Medical University, Peshawar. The course is primarily designed for ophthalmologists and doctors working in the field of Ophthalmology to equip them with the skills of community eye health to provide better eye care services. The course has been modified according to the rules and regulations of Higher Education

MPH students with external examiners Dr. Pararajasaegram, Dr. Babar and PICO's Management

Commission, Pakistan and the duration has been extended from one to two years. With the change in duration the title of the course has also been modified from MSc. Community Eye Health to MPH in Community Eye Health. PICO will also convert it to semester system in the forthcoming years. (Currently the course curriculum is designed for Annual system). The main objective of the course is to develop a team of well trained Professionals to ensure delivery of high quality comprehensive eye health care as part of Comprehensive Health Care. To determine the burden of disease. To train students in understanding the principles of planning, implementation, monitoring and evaluation of Comprehensive Eye Health Care Services in a country/province/region.

2. Progress against activities Admissions Procedure: Based on the learning from the previous years experience this year the course was advertised thrice at an interval of 3 weeks each. This strategy was fruitful and PICO received more application than the available seats for MPH. Total enrolled students were 13, among which 3 were foreigners (1 Srilanka, 2 Indonesian) while the remaining 10 students were from different parts of the country including FATA

Provisional letters of selection were issued to the students in November 2008 and were copied to Higher Education Commission, 10 weeks before the start of classes. Higher Education Commission ensured PICO of getting Visas for overseas students within 5 weeks time, and advised PICO to follow the required steps

MPH students field visit to LRBT Akora Khattak

Academic Activities: All the planned activities for the year 2009 were carried out accordingly. · Field Visits

One of the unique characteristics of PICO's MPH in community eye health is that a part from the basic modules students carried out field visits and participate in different eye care related conferences at provincial and national level. In addition to that students were also exposed to different eye care systems working in the country i.e. Tertiary care hospitals, secondary care hospitals (comprehensive e ye care cells) and charity eye hospitals run by indigenous NGOs. · · · · ·

MPH students on field visit to CEC unit in

Additional subjects of general Public health are also included such as Public health, Anthropology, Communicable and non Communicable diseases, Applied Epidemiology etc. Keeping in view the sustainability and cost effective aspect no external facilitator invited for teaching this year. In addition to the taught Courses Students were taken to different Comprehensive Eye care Cells at district level to learn about their functioning and outcomes. Field visit were carried out to districts hospital (Swabi, Pabbi, Noshera, and LRBT in Akora Khattak) Students participated in a meeting of ophthalmological society of Pakistan held on 2nd May 2009 at Pearl Continental Hotel Bhur Ban.

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Internal evaluation of the students carried out at end of each module. Annual Examination 2009

o Annual examination was conducted in December 2009. Total 14 students were appeared, 13 students were regular student of the year 2009 while one former student who could not got success in the last year. All the 14 students were successfully clear the exam o Exam was conducted under the supervision of the Khyber Medical University, Dr. M. Baber Qureshi and Dr. Para Raja Segaram performed the duty of external examiners. MPH Examination 2009 MPH Admission 2010 o Apart from the regular activities for the year 2009 new admission process for the year 2010 started in September 2009. o Based on the advertisement of admission in all the major national news papers and post on different websites total 21 applications received 6 were foreigners among them. After the selection procedure 15 students were offered admission in MPH for the year 2010. Afterwards the foreigners due to security issue refused to attend the course. Therefore two students who were on waiting list were offered admission. The total number of student in MPH for the year 2010 is 11. o To build /improve the capacity of the PICO faculty relevant faculty member were facilitated to enhance their skills 3. Progress against Objectives: The project envisages the development of appropriate human resource to meet the objectives of Vision 2020 Pakistan. With the addition of community development modules, the course is facilitating the ophthalmologist to learn community approaches and advocacy skills essential for the elimination of avoidable blindness. 4. Progress towards Project Purpose and overall organizational Aims: The trained community ophthalmologists will go to their working place and will utilize the community eye health skill in order to provide quality eye care services to the pro poor and marginalized which will ultimately lead to the project purpose and the organizational aims. Furthermore the practical output of these community ophthalmologists will ultimately help in achieving the V2020 targets.

5. Reviews and learning: PICO is in process to initiate organizational assessment which will also help the institute to review the MPH programme its strength & weaknesses and also the way forward. ToRs are finalized and the assessment of the organization will be conducted by an external consultant. This will enable the partners to define the future plan of actions for PICO. The MPH students are evaluated on regular basis and review the progress of the students and also the facilitators at end of each module aiming to bring the required changes and to overcome the weaknesses if any. 6. Impact of the project: Most of the PICO's graduates are working successfully at their parent organization/ institutions as community ophthalmology after completing MPH. These community ophthalmologists have been contributing to the national programme for prevention and control of blindness and also involved in running provincial prevention of blindness cells in the three provinces. As PICO trained the overseas student in community ophthalmology also they after returning back to their countries serve for quality care in eye health while utilizing their skill from community perspective. Libya and Srilanka are the recent examples where PICO's graduates selected as national Coordinator for prevention of blindness programme in their respective countries. 7. Sustainability: PICO is making efforts towards the sustainability of the MPH programme, one of the important factors is that the course credibility is increasing. PICO received numerous applications from overseas doctors to attend the course for the next academic year. PICO is also working towards offering self finance seats in the near future which will lead the programme to sustain on its own. PICO management conducted a series of meeting with provincial health department to discuss the sustainability aspect regarding courses offered by PICO in the Community Eye Health. The management of PICO was asked by the Secretary Health to prepare a report on institutional setup and activities. Keeping in view the security conditions in the province PICO is also planning to initiate distance ­ learning programme in future. 8. Effect of Security Condition in the Country particularly in NWFP Peshawar on the project: The security condition in the country and particularly in NWFP has also affected the intake of foreign students for the year 2010. PICO based on the advertisement for the year 2010 received 6 applications from different countries including Yemen, Zambia, Nigeria, Saudi Arabia, Afghanistan and Indonesia. But at the last stage after selection they refused to attend the Course because of the prevailing security situation. Therefore the security factor had also effect the attendance of the overseas students and that the govt. closed the educational institutions for summer vacations prior to the scheduled dates. Some of the international faculty of PICO

also had not made their visits to Pakistan & particularly to Peshawar because of the prevailing security conditions. Planned Activities and Milestones for the year 2010 PICO will Offer admissions to 11 students for the year 2010. All the regular modules will be carried out as planned. The other activities (modules) of the course will be the same as were for the past year. Furthermore this year the student will be introduced to other prevention programmes like , Polio campaign , HIV Aid Control programme and Hepatitis Control progrmme etc. aiming to orient the students with the burning public health issues in Pakistan as well as world wide Field visits will be carried out to the eye care unit serving as public or private entity

Annual Project Report of PCVS, 2009

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PAKISTAN CENTRE FOR VISION SCIENCES, PAKISTAN INSTITUTE OF COMMUNITY OPHTHALMOLOGY HAYATABAD MEDICAL COMPLEX, PESHAWAR

Annual Project Report of PCVS 2009

Version - 29/01/2010

Country: Project Title: Project reference (if known) Partners Pakistan Pakistan Centre for Vision Sciences, PICO

HRD Programme

896 SSI, CBM, Light for the World, Dark & Light, FHF Project start date January 1993, official inauguration on 9th October 2001 Currency Cycle/ Phase start date: January 2009 ­ December 2009 Project total duration 8 years Reporting period 2009 Did this project receive restricted Yes Donor As above donor funding over this period? Author: Dr. Khadija N. Abdullah Draft Approved (CR) Comments given (RPO) Comments and Approved (RD) Comments Date: Date: Date: Date: 29. 01.2010

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Annual Project Report of PCVS 2009

Contents

1. Background 2. Progress against activities 2.2 1st year BSc Vision Sciences 2.3 2nd year BSc Vision Sciences 2.4 3rd year BSc Vision Sciences 2.5 4th year BSc Vision Sciences 2.6 Ophthalmic Nursing Course 2.7 Refresher courses 2.8 New admissions for 2010 3. Progress against Objectives 4. Reviews and Learning 5. Sustainability 6. Impact

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2.1 Ophthalmic Technician Training Course

42 46 51 53

7. Progress towards Project purpose and overall organizational aims56 8. Other factors that have affected/may affect the project 9. Planned activities and milestones 10. Recommendations 11. Important events and case studies 12. Annexure 57 59

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Annual Project Report of PCVS 2009

1. Background

The magnitude of blindness and its implications have compelled the world to analyze the situation objectively and adopt comprehensive strategies to combat this menace. The World Health Organization (WHO) in collaboration with the International Agency for Prevention of Blindness (IAPB) has taken the global initiative of eliminating avoidable blindness by the year 2020, under the Vision 2020 programme. In this programme, the concept of Mid Level Eye Care Personnel (MLECP) has emerged as one of the most cost effective measures in both the establishment and strengthening of Comprehensive Eye Care (CEC). It is in this context that Pakistan Centre for Vision Sciences was established as part of Pakistan Institute of Community Ophthalmology, Hayatabad Medical Complex, Peshawar.

1.1 Objectives

PCVS was established to meet the national, provincial and district, Human Recourse Development needs of Mid Level Eye Care Personnel (now called the eye care professionals) with the following objectives: To provide training opportunities for all cadres of eye care professionals, who would then: - increase the coverage of comprehensive eye care and ensure quality and equity while delivering these services; - initiate primary eye care and integrate primary eye care into primary health care; - meet the needs of refractive services of the community. To train some of these MLECP in specific areas of advance visual functions assessment skills, like optometry, ophthalmic technology skills, and public eye health care management skills to meet the needs of tertiary eye care Institutions. To cater for such requirements of the countries of Eastern Mediterranean Region of WHO as well as other developing countries. To develop standardized training programmes in modular form with standardized curricula and national /international faculty. To introduce a standardized system of evaluation.

1.2 Overall Project Purpose and organizational aims

PCVS has continuously progressed towards the over all organizational goal as it has played a vital role in providing high quality affordable and sustainable comprehensive eye care through an integrated effort in areas of HRD, infrastructure development, research and total quality management. 4

Annual Project Report of PCVS 2009

2. Progress against activities

During the year 2009, initially a total number of 107 ophthalmic allied personnel were involved in receiving training in different programmes at Pakistan Centre for Vision Sciences i.e; 1. Ophthalmic Technician Training Course (OTTC), 2009 10 trainees 2. Refractionist Technician Training Course (RTTC), 2009 08 trainees 3. First year BSc. Vision Sciences,2009 22 trainees 4. Second year BSc. Vision Sciences, 2009 25 trainees 5. Third year BSc. Vision Sciences, 2009 21 trainees 7trainees in Optometry 7 trainees in Orthoptics 7 trainees in Ophthalmic Technology 6. Fourth year BSc. Vision Sciences (Internship) 2009 16 internees 6 trainees in Optometry 5 trainees in Orthoptics 5 trainees in Ophthalmic Technology 7. Ophthalmic Nursing Course (ONC),2009 5 trainees It is worth mentioning here that initially eight students joined RTTC but later, one of the RTTC students left the course in the second quarter as she opted for a BSc. Programme while following her, another student got admission at a private medical college and left the course in the fourth quarter. Finally, one of the students of BSc. Vision Sciences failed in the first semester examination and could not be promoted to the second semester according to the rules and regulations of the Khyber Medical University (the BSc. Programme is affiliated with KMU). The academic committee of PICO therefore decided that the student shall be sent home for then and shall join the second semester next year after clearing his first semester examination. As he was a sponsored student, the remaining available funds for him shall therefore be carried over to 2010. In a nut shell, at the end of the year 2009, the total number of students reduced to 104. OTTC, RTTC and 1st year BSc. session started on 19th January 2009 while 2nd year BSc session started on 26th January 2009. The 3rd and 4th year BSc. classes began on 2nd February 2009.

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All the programmes are being conducted in sessions of; · Theory (augmented by practical demonstrations) · Practical placements at the clinical department of Ophthalmology, Hayatabad Medical Complex (HMC), Peshawar. In the theoretical session learning is facilitated via classroom teaching, practical demonstrations and discussion. Details of each course are as follows:

2.1 Ophthalmic Technician Training Course (Diploma), 2009

The Ophthalmic Technician Training Course Year 2009 started on 19th January 2009. The total number of candidates (all in-service) who finally joined the course was 10. Details of the students are as follows:* S. No Name Mardan Hangu Ghizar Haripur Pattan, Kohistan Faisalabad Faisalabad Faisalabad Swat Buner District NWFP NWFP Northern Areas NWFP NWFP Punjab Punjab Punjab NWFP NWFP Area Sponsor FHF SSI LFTW CBM SSI LFTW CBM FHF D&L D&L

2.1.1 General information

1 Vovrine Khan Yousafzai 2 Zahir Gul 3 Asad Ullah Baig 4 Saad Masood Qureshi 5 Zahid Ali 6 Sohaib Khalid 7 Kashif Masih Gill 8 Asim 9 Umer Rashid 10 Fazal Alim

* The lists of students for all the courses are different from the ones sent in the

first quarter. This is because we have rearranged the lists for our convenience however the total number of students per donor remains the same.

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A group photo of OTTC students

2.1.2 Theory classes

The students were busy in their theoretical classes covering the basic sciences i.e; General Anatomy, Physiology, Biochemistry and Pathology during the first two quarters. English Language, communication and computer skills & Islamiyat classes were also arranged for the students as per the requirements of the curriculum. The students were sent on a break from 17th May-17th of August in compliance with the Govt. orders owing to the security situation in the province.

OTTC class in progress

The classes re-started on 18th August. The Medical Faculty, NWFP (OTTC is affiliated with the Medical Faculty)had not announced the much awaited schedule for the 1st 7

semester examination. The course work for the said semester had been completed in the second quarter therefore the course work for the second semester was started in third quarter without any delay. It was completed in the middle of the fourth quarter. The practical placement of trainee ophthalmic technicians started in the 4th quarter. For practical work the students were placed at: · Eye ward · Eye OPD · Eye OT During these placements the students were given opportunities to perform the relevant skills under supervision to facilitate the acquisition of necessary skills required of them in various ophthalmic settings. Tasks, which the trainees performed at their clinical stations included: a. b. c. d. Taking relevant & concise history Examining the patients Assisting in proper record keeping Performing specific tasks relevant to the clinical setting i.e. OT/ OPD / Eye ward.

2.1.3 Practical placement

A practical demonstration at the OPD, HMC

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It is unfortunate that due to the break that was not pre-planned, the students had insufficient time for the practical work. Moreover, no time was left for revision sessions for the students.

2.1.4 Examinations

OTTC is based on semester system and it is a two-year course now (initially one-year) as prescribed by the Medical Faculty, NWFP- the only registering body for health technicians in the province. PICO has funding available for one year only therefore, all the course work is completed in one year while for the next year, the student is placed at the department of Ophthalmology of the parent hospital (that nominated him/her) for a one-year internship under supervision. The Medical faculty, NWFP was expected to conduct the 1st semester examination in the month of July but unfortunately, it was conducted from 26th- 28th October. Obviously, it was very late. The result is still awaited. The schedule for the second semester has not yet been announced by the Faculty. The students shall be following the schedule once it is announced.

2.1.5 Students' counseling

Some of the students were not regular in the first two quarters. They were constantly counseled by the faculty members and also given written warnings. Most of them did respond positively to these steps. However, one of the students persisted to display a non-serious attitude towards his studies. His case summary has been sent to the academic Committee of PICO for a final decision regarding cancellation of his admission.

2.2 Refractionist Technician Training Course, 2009

2.2.1 General information

The new Refractionist Technician Training Course started on 19th January 2009. A total of 130 applications were received for admission in BSc. Vision Sciences/ RTTC and the first priority of all the candidates was BSc. Vision Sciences. The first 20 candidates on the merit list were offered admission in BSc. Vision Sciences while the next 20 were selected for RTTC. However, majority of the candidates selected for RTTC refused to join the course and the candidates on the waiting list were then offered the course. It was decided to complete the admission process within a month after the commencement of the classes so that the students joining late and the faculty members can manage well. After a month of the commencement of the session, the number of candidates who finally joined the course was 8. Candidates who declined the admission offer had apprehensions about the future scope of this very new programme. It is the first batch of RTTC and details of the students are as follows:

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S. No

Name 1 Ahmad Iqbal 2 Maryam Saad 3 Samreen Sultan Khattak 4 Seema Maqbool 5 Nabila Hanifa 6 Faisal Nadeem 7 Muhammad Kashif 8 Rizwan Nisar

District Charsadda Mardan Peshawar Peshawar Swabi Malakand Agency Swat Peshawar

Province NWFP NWFP NWFP NWFP NWFP NWFP NWFP NWFP

Sponsor SSI LFTW FHF SSI CBM D&L FHF CBM

One of the students left the course after the completion of the first quarter. She had doubts about her future as a refractionist and was counseled many times by different faculty members- however, she finally decided to leave the course on the grounds that she wanted a BSc. degree (be it in any subject) and not a Diploma!. Another student also left the course in the fourth quarter when she secured admission at a private medical college. The number of students at the end of the first year therefore was 6.

Group photo of RTTC (1st year) students

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The students were busy in their theoretical session in the first two quarters. The subjects covered during the specified period were introduction to general Anatomy, Physiology, Pathology and Biochemistry; Anatomy and Physiology of the eye and the common diseases of the eye. The RTTC students also attended communication and computer skills, Islamiyat and English language classes. They were to have their first term examination in the first week of June however, they were sent on vacations from 17th of May- 17th of August on an emergency basis owing to the unfavourable security circumstances.

RTTC students in a combined class

The classes re-started on 18th August. RTTC students had their 1st term examination (postponed earlier) from 24th ­ 27th August 2009. The students had a combination of theoretical and practical sessions on basic clinical skills and advanced visual function assessment in the third and fourth quarter. The English language classes continued during the third quarter as well. On the conclusion of regular academic session, the students had a special revision session (2 weeks).

2.2.2 Practical placement

The practical placements of trainee refractionists started in the fourth quarter. Once again, the time for the practical work was far less than planned due to the break mentioned above. Tasks, which the trainees perform at the clinical stations, are: a. b. c. d. Taking relevant & concise history Examining the patients Assisting in proper record keeping; Performing specific tasks relevant to the clinical setting i.e. OT/ OPD / Eye ward.

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A trainee refractionist assessing VA at OPD

The first term internal examination was conducted from 24th -27th August. Majority of the students didn't do very well in the examination and were counseled according to their individual performances. Final examination for the RTTC 1st year was held on 5th ­ 12th December 2009 under the supervision of the Khyber Medical University. The examination consisted of: o Theory (6 papers) o Practical & Viva; (TOACS was conducted).

2.2.3 Examinations

RTTC, theory papers and viva exam in progress

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The board of examiners included; o Dr. Zia Mohammad, Consultant Ophthalmologist, Mardan. o Dr. Khadija N. Abdullah, Director PCVS. The result is awaited.

2.3

1st year BSc. Vision Sciences, 2009

2.3.1 General information

The 1st year BSc. Vision Sciences 2009 started on 19th January 2009. Ten students were admitted against the regular sponsored seats. Eight admissions were done on self-finance basis while the two vacant sponsored seats of RTTC were transferred to BSc. Vision Sciences. Two additional students were sponsored by Dark & Light this year. The total number of candidates who joined the course therefore was 22. Further, when one of the RTTC students left the course after the 1st quarter, her seat was transferred to BSc. 1st year and the student on the top of the merit list in the selfsponsored category was adjusted against it leaving behind 7 self-sponsored students.

BSc.1st year students

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Details of the students are as follows: S. No Name 1 Mandana Haroon 2 Rameez Ullah 3 Summaya Umer 4 Salman Khan 5 Fozia Haleem 6 Amjad Hussain 7 M Ibrahim 8 M Ali Khan 9 Abidullah 10 Saifullah 11 Abdul Hafeez 12 Zakir Ali 13 Noor Zia Bano 14 Aftab Ahmad 15 Naeemullah 16 M Anwarul Haq 17 Sheema Saira 18 Shazia Gul 19 Hamid Ahmad 20 Faisal Khan 21 M. Jamal Khan 22 Jawad Ahmad District Peshawar Peshawar Lower Dir Swat Mardan Malakand Agency Kurram Agency Peshawar Buner Charsadda Quetta Lower Dir Chitral Chitral Lower Dir Bajour Agency Nowshera Mardan Mardan Nowshera Peshawar Swabi Area NWFP NWFP NWFP NWFP NWFP NWFP FATA NWFP NWFP NWFP Baluchistan NWFP Northern Areas Northern Areas NWFP NWFP NWFP NWFP NWFP NWFP FATA NWFP Sponsor SSI D&L FHF LFTW SSI CBM LFTW CBM CBM FHF CBM D&L ECWW ECWW NWFP Self Sponsored Self Sponsored Self Sponsored Self Sponsored Self Sponsored Self Sponsored Self Sponsored

Later, one of the students failed in the first semester examination and could not be promoted to the 2nd semester as per University rules. Therefore, the number of students at the end of the year was 21. It is worth mentioning that the BSc. Vision Sciences curriculum was reviewed last year and the revised curriculum approved by the Khyber Medical University (KMU) is applicable from 2009 onwards. The revised BSc. Programme is based on semester system instead of the earlier annual system. In addition, the new curriculum places more emphasis on basic sciences and encourages an integrated practical training in contrast to the previous approach where practical training and theoretical sessions were conducted in somewhat isolation. During the first semester the students had 14

detailed interactive sessions on general Anatomy, Physiology and Biochemistry. English Language, communication and computer skills, Islamiyat & mathematics classes were also arranged as per requirements of the revised curriculum. They had the mid-semester examination in the first week of May.

Class room teaching

The 1st semester university examination was to be held in the first week of June but as the students had to be sent on vacations in emergency due to security concerns, it was postponed. The students came back from their vacation on 18th August. They had their 1st semester university examination from 24th ­ 28th August. After the examination, the classes for the 2nd semester on the subject of Pathology, General Pharmacology and public Health were started. The English language classes continued throughout this semester. On the conclusion of the academic session, the students had 2nd semester examination.

2.3.2 Examinations

The mid-semester examination was conducted in the first week of May. All the students except for one were successful. The failed student had some serious personal issues and could not take two papers. He was counseled to work hard in order to compensate for his performance in the final semester examination. The 1st semester final examination was conducted from 24th-28th August under the supervision of the Khyber Medical University. The result was declared on 10th November 2009. The total number of students who appeared in the examination was 22. Twenty one (21) students were declared successful. The only failed student was sent home as he could not be promoted to the next semester (University rules). He now has to pass the first semester examination next year before joining the 2nd semester.

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BSc, 1st semester exam

The 2nd semester final examination was held on 7th ­ 11th December. Two of the 21 students were absent in some papers. Both the semester examinations comprised of theory papers only covering the subjects of basic sciences, Islamiyat, mathematics and English language.

BSc, 2nd semester exam

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2.4

2nd Year BSc. Vision Sciences, 2009

2.4.1 General information

The result of the 1st year BSc. Vision sciences, University examination 2008, was declared on 19th January, 2009 by the Khyber Medical University. The total number of students who took the KMU 1st year 2008 examination was 26. Only one student failed hence the pass percentage was 97. Twenty five students who passed the exam were promoted to the 2nd year. As sponsorship is available for 20 students, the top twenty among the passed students were promoted against the available sponsored seats and the remaining five were initially promoted on self-finance basis. The latter submitted an application that they were not able to bear the expenses themselves as most of them were from areas where there are serious law & order situation and economy has deteriorated. PICO considered their application sympathetically and it was decided that they shall be allowed to continue in a way that PICO shall not charge them with the tuition fee but at the same time they shall not get any facilities including the medical kit & stipend.

A group photo of BSc. 2nd year students

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Details of the students are as follows:

S. No

Name

District Mardan Kohat Peshawar Lower Dir Peshawar Mardan Mardan Charsadda Mardan Peshawar Mardan Shangla Swabi Swabi Swat Lower Dir Mardan Bajaur Agency Lakki Marwat Lower Dir Swat Peshawar Miranshah Upper Dir Khyber Agency

Sponsor LFTW SSI FHF SSI D&L SSI D&L SSI SSI LFTW LFTW SSI LFTW CBM CBM CBM CBM FHF FHF FHF

1 Syed Shabbir Alam 2 Arifa Sajjad 3 Sonia Tahira 4 Mujeebullah 5 Shawana Shams 6 Ihteraz 7 Naila Rauf 8 Zeeshan Ahmad 9 Saima Siddique 10 Qazi Muhammad Omair 11 Hira Ali 12 Imran ul Haq 13 Hina Gul 14 Sumbal Habib 15 Farhad 16 Tariq Ahmad 17 Mahpara Aziz 18 Palwasha Noor 19 Salim Khan 20 Riaz Iqbal 21 Naseerya Bibi 22 Naila Noor 23 Mohammad Sadiq 24 Mohammad Ibrahim Jan 25 Abdur Rahman

* * * * *

*The students have been considered on special sympathetic grounds. PICO is able to mange them within the available budget by not providing them with the medical kit and the monthly stipend. However, the students have been exempted from the tuition fee. 18

The 2nd year BSc. Vision Sciences classes started on 26th January, 2009. The students were busy in their theoretical session in the first two quarters. The subjects covered during the specified period were physical, visual and geometrical optics, clinical refraction, low vision, contact lenses and orthoptics. Their mid-term examination was to be held in the first week of June but as for other courses, this too had to be postponed and the students were sent on a break till 17th of August.

A class in progress After the break, the 2nd year students had their mid-term examination from 24th ­ 28th August 2009. The students had a revision session (3 weeks) at the end of the academic session. Main focus during the session was on concept building and clinical aspects of the topic revised.

2.4.2 Practical placement

The practical training started on 1st September at the deptt. Of ophthalmology, HMC, Peshawar. However, the theoretical classes were also arranged regularly during the practical session to cover a few remaining topics and revise others. The students were placed at: Refraction Room Low Vision Clinic Consultant Rooms New Refraction Cubicles Paedriatic clinic Diagnostic room, biometry, FFA and lasers

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A trainee managing patient under supervision

2.4.3 Examinations

The mid-term examination held from 24th -28th August, yielded very encouraging result with only two students scoring below 60%. The latter were counseled by the faculty to help them improve their performances in future. The final University examination was held from 18th ­ 24th December under the supervision of the Khyber Medical University, Peshawar. The examination consisted of: o Theory (5 papers) o Practical & Viva; (TOACS)

BSc. 2nd year, theory and practical exam in progress

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The board of examiners included: o o o o Prof. Shad Mohammad, Director AA & QA, KMU, Peshawar Dr. Mehfooz Hussain, Senior Registrar, Lady Reading Hospital, Peshawar. Mr. Ali Minto, Optometrist, Islamabad. Dr. Sanaullah Jan, Senior Registrar, HMC, Peshawar.

Mr. Ali Minto facilitating the BSc. 2nd year practical exam The result is expected in the last week of January, 2009.

2.5

3rd year BSc. Vision Sciences, 2009

2.5.1 General information

The result of the 2nd year BSc. Vision Sciences, University examination, 2008 was declared on 31st January, 2009 by the Khyber Medical University. The total number of students who took the KMU 2nd year 2008 exam was 19. They all passed and hence were promoted to the 3rd year. One student of previous session who had failed last year, re-appeared in the exam and was declared successful this year, he too was therefore promoted to the 3rd year on self finance basis initially. Later, he was exempted from the tuition fee on his request. He is an in-service candidate and PICO aims at encouraging the in-service personnel to upgrade their academic qualifications. The medical kit and stipend however was not provided to the student to make his stay financially feasible. This year, a candidate from Punjab applied for a one-year certificate course in Orthoptics at PICO. The candidate had already completed a Diploma from Al-Shifa Trust Eye Hospital, Rawalpindi but felt that he needed to further improve his knowledge and skills. After a thorough discussion, he was allowed to join the 3rd year (Orthoptics) on self-finance basis. However, it was made very clear that he shall be granted a one-year certificate at the end of the year that can never be considered to be equivalent to BSc. Vision Sciences (Orthoptics) offered at PICO for any purpose.

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There are three sub-specialties in 3rd year BSc. Vision Sciences i.e; Optometry, Orthoptics and Ophthalmic technology with a total number of 21 students. The selection of students in the three categories of 3rd year is based on their 2nd year marks.

BSc 3rd year students

Details of the students are as follows:

OPTOMETRY (7)

S. No 1 2 3 4 5 6 7 Name Faheem ullah Mohammad Arshad Asmatullah Huma Hasan Mohammad Qasim Noor ul Ain Mohammad Zubair District Lakki Marwat Hangu Mardan Peshawar Swabi Swat Haripur Sponsor SSI CBM D&L D&L CBM LFTW LFTW

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ORTHOPTICS (7)

S. No 8 9 10 11 12 13 14 Name Kanwal Ahad Saima Bibi Tofique Hussain Farman Ali Ayat Shah Abdur Rahman Mehr Wali* District Swat Abbotabad Haiderabad Swabi F. R. Peshawar Charsadda Attock Sponsors SSI SSI LFTW LFTW FHF CBM Self Sponsored

* For a one-year certificate course in Orthoptics

OPHTHALMIC TECHNOLOGY (7)

S. No 15 16 17 18 19 20 21 Name Naila Habib Khan Riaz Ahmad Saira Nosheen Asif Afridi Naveed Ahmad Mustafa Rashid Masood Khan District Bajour Agency Buner Bannu Batagram Mohmand Agency Miranshah, NW Ag. Peshawar Sponsors LFTW LFTW CBM FHF FHF FHF Self Sponsored

The classes started on 9th February 2009. The theoretical sessions were completed for the three sub-specialties as per schedule (Please see the attached year planner). To enhance the learning process all faculty members of PCVS and doctors from clinical department of Ophthalmology, HMC were involved in these sessions. Prof Shad Muhammad delivered special combined classes on ERG, EOG, Visual fields and lasers.

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Mr. Ali Minto and Prof. Shad facilitating theory sessions

The students were on break from 17th May till 17th August 2009 owing to the security concerns at that time. During the 3rd quarter the students had their 1st term examination from 24th ­ 26th August 2009.

2.5.2 Practical placement

After the 1st term examination the students were placed at different clinical stations at the deptt. Of Ophthalmology, HMC, Peshawar according to their sub-specialties.

Students learning skills at the eye OPD, HMC

24

For the practical work the students were placed at: Orthopitcs course Orthoptics clinic Paedriatic clinic Optical Lab Optometry course Refraction Room Low Vision Contact lens clinic Optical lab Ophthalmic technology course Visual field Biometry FFA, Lasers etc Technology lab On conclusion of the academic session, a short revision session was arranged before the final examination. The mid-term examination was conducted from 24th-26th August. Six (6) students who did not do well in the exam were counseled by the faculty members in order to guide them on how to do better in future. The final University examination for the 3rd year BSc. Vision Sciences was held from 10th ­ 21st December 2009 under the supervision of the Khyber Medical University, Peshawar. The examination consisted of: o Theory (3 papers) o Practical & Viva (TOACS)

2.5.3 Examinations

BSc 3rd year theory paper in progress

25

The board of examiners included: Ophthalmic Technology (Practical exam on 14th December 2009) o Dr. Sofia Iqbal, Assistant Professor, Ophthalmology deptt. HMC, Peshawar. o Dr. Tariq Marwat, Ophthalmologist, HMC, Peshawar.

3rd year ophthalmic technology practical exam

Orthoptics (Practical exam on 15th December 2009) o Dr. Tariq Marwat, Ophthalmologist, Ophthalmology Deptt. HMC, Peshawar o Mrs. Nusrat Naseem, Orthoptist, Shifa International, Rawalpindi

BSc. 3rd year Orthoptics, practical exam

26

Optometry (Practical exam on 21st December, 2009) o Mr. Hasan Minto, Regional Advisor SSI, Islamabad. o Dr. Sanaullah Jan, Senior Registrar, Ophthalmology Deptt. HMC, Peshawar.

BSc 3rd year Optometry student taking practical exam

The result is expected in the last week of January, 2010.

2.6 4th year BSc. Vision Sciences (Internship), 2009 2.6.1 General information

The internship commenced on 2nd February 2009. We have 13 sponsored regular seats for 4th year BSc (Internship) but the students who took the 3rd year 2008 KMU exam was 16. All of them passed hence were promoted to the 4th year. The institute has adjusted sixteen students in the available funding.

The internees and 3rd year in a class party

27

Details of the students are as follows:

OPTOMETRY (6) S. No 1 2 3 4 5 6 Name Sumayya Naseem Ayesha Rahman Israj Gul Abdullah Jamil Ahmad Javed Hassan District Peshawar DI Khan Mohmand Agency Bannu Dir Lower Lower Dir Sponsor LFTW LFTW SSI CBM LFTW LFTW

ORTHOPTICS (5) S. No 7 8 9 10 11 Name Nazish Rahman Taj Mohammad Shakeel ur Rahman Anwar Zeb Shamsul Wahab District Nowshera Khyber Agency Malakand Peshawar Peshawar Sponsor LFTW LFTW D&L CBM CBM

OPHTHALMIC TECHNOLOGY (5) S. No 12 13 14 15 16 Name Iqbal Ahmad Muhammad Zia ul Haq Naveed Iqbal Muhammad Saboor Abdus Salam District Dir Upper Mardan Mir Ali, NW Agency F.R Bannu Mingora , Swat Sponsor D&L CBM D&L CBM CBM

All internees were placed at the department of Ophthalmology at Hayatabad Medical Complex. The internees were performing their duties at OPD according to their specialties. They too were sent on a break from 17th May- 17th August as per the Govt. orders. Unfortunately, it wasted their precious time.

28

Internees working under clinical supervision at OPD

The internees resumed their duties at the clinical deptt. of Ophthalmology, HMC at the following stations on rotation: · · · · · · · Female and male refraction cubicles at lower OPD Diagnostic and laser rooms Orthoptic clinic Refraction room Low Vision clinic Contact Lens clinic Consultant rooms

The internees have to conduct an individual research project and produce a report as a compulsory requirement of the BSc Vision Sciences. A module on research methodology was conducted by Dr. Zahid Jadoon, the Epidemiologist at PICO to help them prepare their research protocols. The internees prepared their research protocols after summer break and submitted these for ethical approval. They conducted their approved individual research projects and prepared the reports in the third quarter. In spite of the poor law and order situation in the province, they were all able to complete their field work successfully.

29

Dr. Zahid Jadoon (Epidemiologist) conducting session on research methodology

The research topics of individual students are given below:

S. No 1.

Name Taj Mohammad

2.

Summaya Naseem

3.

Ayesha Rahman

4.

Israj Gul

5.

Jamil Ahmad

6.

Mohammad Saboor

7.

Javed Hasan

8.

Shamsul Wahab

Title School screening for refractive error among children aged 11 ­ 15 years at Govt. High School Sama Garhi Millward Bara, Khyber Agency To estimate the frequency of refractive error in female patients who attend eye OPD at HMC Peshawar Frequency of refractive errors in children age group 5 ­ 15 years visiting the eye OPD, HMC, Peshawar Visual outcome of low vision devices in functional low vision patients of all age groups at low vision clinic, eye OPD , HMC, Peshawar Causes of severe visual impairment and blindness in children studying at school for the blind in Peshawar Prevalence of refractive errors among children aged 11-16 year at IQRA Public High School for boys, F.R. Bannu Screening for refractive error and visual impairment among school children aged 1015 years at union council Shahi Khel Talash dir, Lower Dir. To estimate the prevalence of refractive error

Area Bara, Khyber Agency HMC Peshawar HMC Peshawar HMC Peshawar

Peshawar

F.R. Bannu

Lower Dir

30

9.

Naveed Iqbal

10.

Abdus Salam

11. 12.

Abdullah Muhammad Zia ul Haq Nazish Rahman

13.

14.

Anwar zeb

15.

Shakeel ur Rahman

16.

Iqbal Ahmad

in children aged 11 ­ 16 at Frontier Grammar Public high school Manzoorabad Duranpoor, Peshawar Prevalence of cataract in age group 40 years and above, at Tehsil Miranshah, North Waziristan Agency. Frequency of the common eye diseases among children at Saidu Group of Teaching Hospital, Saidu Sharif, Swat. The prevalence of refractive error among the school children aged 11-16 years at Bannu. Screening of children for refractive error in age group 11 ­ 16 years at Govt High School, Jalala, Mardan To assess the frequency and type of squint among the patients attending eye OPD at HMC, Peshawar Prevalence of refractive errors among school children aged 11-16 years, Kohat Road, Peshawar. Frequency of cataract in the age group of 30 years and above at the eye OPD of district hospital Batkhela, District Malakand Prevalence of refractive errors and visual impairment among school children, Sec F, Islamabad

Peshawar Miranshah N. W Agency. Swat

Bannu Mardan

HMC, Peshawar Peshawar

Malakand

Islamabad

2.6.2 Examinations

A special examination was conducted for some students who were irregular during the internship. The academic committee decided to allow them take the final University examination only, if they would pass the special examination. All the students passed the examination. On conclusion of the academic session, final examination for the 4th year BSc. Vision Sciences was held from 14th ­ 22nd December 2009 under the supervision of the Khyber Medical University, Peshawar. The examination consisted of Practical & Viva only (TOACS). Four failed students of the previous batches also took the examination. The board of examiners included: Ophthalmic Technology (14th December 2009) o Dr. Sofia Iqbal, Assistant Professor, HMC, Peshawar o Dr. Tariq Marwat, Ophthalmologist, HMC, Peshawar.

31

An internee ophthalmic technologist taking exam Orthoptics (15th December 2009) o Dr. Tariq Marwat, Senior Registrar, HMC, Peshawar. o Mrs. Nusrat Naseem, Orthoptist, Shifa International, Rawalpindi

4th year Orthoptics exam in progress

32

Optometry (22nd December 2009) o Mr. Hasan Minto, Regional Advisor SSI, Islamabad. o Dr. Sanaullah Jan, Consultant Ophthalmologist, HMC, Peshawar. The result is expected to be declared in the last week of January, 2010.

BSc. 4th year Optometry exam

2.7 Ophthalmic Nursing Course, 2009 2.7.1 General information

It is important to note that PICO and the Postgraduate College of Nursing, NWFP, have agreed to closely collaborate and it was decided last year that from 2009 onwards, the admissions for ONC and the preparation of year planner shall be done by the College with help from PICO wherever needed. Moreover, it was also agreed upon that PICO shall extend its full support to the College in implementing the curriculum and provide medical kits, books and monthly stipend to the five top students. The admissions were therefore done by the College of Nursing, with mutual consensus. Five applicants were selected for the course. Details of the candidates are as follows:

33

S. No 1 2 3

Name Riffat Bano Riffat Naz Jojce Jalal Salima Jalal

4 5 Nigar Begum

Present Service Khyber Teaching Hospital, Peshawar Peshawar Khyber Teaching Hospital, Charsadda Peshawar Hayatabad Medical Peshawar Complex, Peshawar Lady Reading Hospital, Peshawar Peshawar Children Hospital, Haji Mardan Camp, Peshawar

District

Province NWFP NWFP

Sponsors SSI CBM

NWFP LFTW NWFP D&L NWFP FHF

The students were busy having theoretical sessions on general principles of nursing care, communication skills and anatomy, physiology and common diseases of the eye at the College and PICO during the first quarter. They were also invited to PICO in February to receive their medical kits.

The students of ONC discussing their assignments with Dr. Khadija Abdullah

34

Distribution of kits by the Director Fund raising, FHF In the first two weeks of April- , the students had three alternate days of theory classes at PCVS and practical placement at the Ophthalmology department, Hayatabad Medical Complex. Mrs. Afshan Tabassum, in- charge Ophthalmic Nurse at the Ophthalmology department supervised them.

ONC students attending a class at PICO

During the third quarter, PICO did not receive any information form the College about the academic activities of the students. On inquiry, it was communicated informally that the students were being placed at the clinical deptts. of different teaching hospitals in Peshawar. However, the College was informed about the concerns regarding non-communication of the activities. A positive response was given and during the last quarter, the course coordinator at the College kept us well informed about the students. The students prepared their journals, essays and brochures and presented information on the assigned topics. 35

2.7.2 Examination

The final examination was conducted in December. Dr. Khadija Abdullah was invited as an examiner for the final presentations of the student. The result has been declared and all five students have been successful. The College has also provided copies of different assignments completed by the students to be placed at the resource centre. PICO appreciates the inputs from the College as these are steps towards better and effective collaboration and training.

2. 8 Refresher Courses for Ophthalmic Technicians , 2009 2.8.1 The 1st refresher course

PICO conducts refrsher course for qualified ophthalmic technicians from all over Pakistan, biannually. The 1st refresher course for the year 2009 was conducted from 4th-9th of May. Though 20 candidates were nominated for the course, 15 could finally make it. The reason for non-attendance was poor security situation in many districts that did not permit some of the candidates to leave behind their families for a week.

Participants of the 1st refresher course in an interactive class

36

The details of the participants are as follows:

S. #

1. 2. 3. 4. 5. 6. ` 7. 8. 9. 10. 11. 12. 13. 14. 15.

Name

Qaiser Younis Sheraz Barkat Jangeer M. Tufail Abdul Qayum Shah Bakht Rawan M. Ismail Safdar Hussain Mohammad Khalid Naseerullah Hayat Gul Sajjad Khan Peer Zad Khan Timur Nasreen Bibi ALP MALC MALC

Destination

Eye Care Chitral DHQ Hospital, Batkhela MALC MALC ALP HMC, Peshawar KTH, Peshawar KTH, Peshawar DHQ Hospital, Charsadda HMC, Peshawar Mission Hospital, Peshawar DHQ Hospital, Chitral

2.8.2 The 2nd refresher course

The 2nd refresher course was conducted from 16th ­ 21st November 2009. Though 24 candidates were nominated for the course, 20 could finally make it for the refresher course.

Participants with Prof. Nasir Saeed

37

The details of the participants are as follows: S. # 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Name Sultan Mohammad Zulfiqar Ahmed Mohammad Essa Farooq e Azam Waheedullah Zafar Maqbool Tayyab Jan Tufail Wali Khan Sheraz Khan Mohammad Wali Zia ul Haq M. Afzal Abassi Ejaz Ahmad Habib ur Rahman Maqsood Ayaz Mohammad Tahir Saeedullah Ihtisham Justan Mohammad. Asif Destination Helper Eye Hospital, Quetta Akora Khattak, Distt. Nowshera Khuzdar Quetta.2001-2002 MALC Peshawar DHQ Hospital, Nowshera DHQ Hospital Turbat, Baluchistan BHU Tordher, Swabi DHQ Hospital, Timargara, Dir DHQ Hospital, Lakki Marwat HMC, Peshawar KTH, Peshawar LRH, Peshawar CMH, Muzaffarabad, AJK Ayub Medical Complex, Abbotabad. Saidu Group Hospital, Swat DHQ Hospital Swabi Helper Eye Hospital Quetta DHQ Hospital Timergara United Christian hospital, Lahore DHQ Hospital Haripur

The feedback given by the participants of both the refresher courses was very encouraging as almost all of them found it very useful and relevant to their professional responsibilities.

38

2.9 New Admission for 2010

The new admissions for BSc. Vision Sciences, the Refractionist Technician Training (Diploma) Course and Ophthalmic Technician Training (Diploma) Course were advertised and completed in the last quarter of 2009. The admissions were advertised in national daily newspapers and also on the website of PICO. The allocation of seats was as follows: S. no Proposed intake (total) 1 2 3 4 BSc. Vision Sciences Refraction technician training Course (RTTC) Ophthalmic technician training course(OTTC) Ophthalmic Nursing Course (ONC) 30 20 10-15 5-10 Break up Sponsored 15 10 10 5 Self-finance 15 10 May vary ---------

Course

For BSc, RTTC and OTTC, a total of 200 admission forms were submitted from different areas of Pakistan by in-service and fresh candidates. The admission test for BSc and RTTC was held on 10th November 2009 at PICO. One hundred and fifty two (152) students appeared in the test.

Admission test at PICO in progress For OTTC, 13 nominations were received through proper channel. Finally, 30 candidates were offered admission in BSc (15 in sponsored and 15 in self-finance category) and 20 in RTTC (10 in sponsored and 10 in self-finance category) against a pre-determined merit formula. Ten eligible applicants for OTTC were offered admission against the 10 sponsored seats. The candidates are now in the process of 39

joining the course. In case a candidate does not join the course, his/her seat shall be offered to the next candidate on the merit list. The new sessions are to commence on 18th of January, 2010. The final students' list shall be available within a month after this. It is worth mentioning that three candidates from Baluchistan had also applied for BSc. Vision Sciences. The admission committee decided to offer admission to all of them as a special case (1 open merit, 2 self-sponsored) owing to the lack of opportunities for education at Baluchistan and the fact that under the current poor state of affairs at this province, it was not possible for the candidates to compete for the open merit category. PICO requested FHF to sponsor an additional candidate on the top of the merit list for Baluchistan only. We are grateful to FHF for catering our request and assisting us in training people from a very needy province of Pakistan. The College of Nursing also advertised the admissions for ONC, 2010. They are in the process of finalizing the admissions and are expected to complete the process by the end of January, 2010. The master year planner for the year 2009 is attached with the report as annexure I.

40

Annual Project Report of PCVS 2009

3. Progress against Objectives

The set objectives of PCVS included the provision of training opportunities for all cadres of eye care professionals who in turn would ensure increased coverage of quality eye care services and integration of PEC into PHC. This would also fulfill the refractive services needs of the community. The courses at PCVS are successfully meeting these objectives as we have been able to train all cadres of MLECP not only from NWFP but, also from allover the country. We are proud to share that the all the resident faculty members of PCVS have been trained at PCVS and are contributing their valuable services to HRD for the country. Regarding service delivery, our trained MLECP is serving the community in different capacities hence is playing a key role in standardized eye care service delivery. Our qualified trainees are working in currently difficult areas in terms of the poor security situation there such as in Swat and neighboring areas, the tribal agencies and Shabqadar hence serving the people in dire need of eye health care. The graphs below are the evidence of our success story clearly indicating that we have been able to achieve our targets most of the times with a very few exceptions. Where ever we were falling short, we were able to compensate for it in other years when we exceeded our targets.

This year, two of our faculty members were involved in school screening for refractive error at Zambia followed by refraction and prescription of spectacles as a part of a project by SSI. Human resource produced at PCVS is therefore not catering for the PEC needs of Pakistan but other developing countries as well.

41

Trainig of Ophthalmic Technician at PICO 1993-2009

50 45 40 35 30 25 20 15 10 5 0

19

44 39 29 29 28 20 10 10

T arg et

27 21 15 16 15 17

25

7

93

06

94

96

95

97

99

00

00

00

00

00

00

07

08 20 rt ra in i ng

9

0

1

2

3

4

5

19

20

19

19

-2

-2

-2

-2

-2

-1

-2

20

19

99

00

01

02

03

19

20

20

20

19

20

20

04

98

Total= 352 Total Trained Students 353

1st Year BSc. Vision Sciences 2001-2009

Total= 139

30 26 25 20 19 14 10 10 5 0 2001 2002 2003 2004 2006 2007 2008 2009 10 14 24 22

T a rg e t

15

Un

de

20

09

42

43

It is important to mention that we believe in producing HR with an emphasis on its quality. In this regard, our courses curricula were thoroughly reviewed in 2008 and the revised curricula were successfully implemented this year. PICO is also under going an organizational evaluation very soon and this too shall help us in further enhancing the quality of HR produced by our institute.

44

Annual Project Report of PCVS 2009

4. Reviews and Learning 4.1 The effects of security situation in the province

The adverse security circumstances in the province did affect the students of PCVS as many of them belong to the sensitive areas. Some of them became IDPs. They were very disturbed and worried about their families and the faculty kept on counseling them. In mid-May, the govt. had to announce that all the educational institutes should send the students on vacations due to serious security threats. The "emergency summer break" resulted in delayed examinations and adjustments in the year planner had to be made to ensure that no compromise is made on the quality of the training. In spite of all the measures, after the break, the time left for the practical training was insufficient. Some of the students belonging to the tribal agencies became quite irregular due to the imposed curfew at times. However, in the last quarter, the situation improved. PICO arranges recreational tours for its students each year. In spire of a demand from the students, we did not allow such tours this year due to security concerns in the province. The importance of refreshing the students is well understood but their security is a priority and we may decide according to the security situation in future. Moreover, it was decided to provide an opportunity for co-curricular activities to the students- the students too requested for such initiatives many times. The initiative aimed at providing a healthier environment to the students and also helping them cope with the anxiety they were facing due to the security situation. Unfortunately, we were in the process of planning for different events when the govt. asked all the institutions to announce the summer break. However, when the students came back, the out door sports facilities were already made available and a class-wise schedule for games was in place.

4.2 The future of RTTC

The new Diploma in Clinical Refraction faced its first set back when only 8 out of the 20 candidates who were offered admission (10 on regular sponsorship and 10 on self-finance basis) joined the Programme and the rest declined the admission offer. However, it was not a surprise and such an event was anticipated owing to the fact that a new Programme needs some time to establish itself. Moreover, individual meetings were arranged with the candidates who did not join and an effort was made to make them aware of the scope of this Programme and address their apprehensions about the future of this qualification. Most of the students who joined the Programme were constantly pressurized by their families to try to get transferred to the BSc. Programmme. Frequent counseling was given to them by the faculty members and it did bring in them the required level of confidence among them to continue with the course. The experience compelled us to plan for a better outcome in future. It unfortunately, had another set back when one of the 45

students dropped out in the 2nd quarter followed by yet another drop out in the 4th Quarter. In addition, two students applied for BSc. Vision Sciences, 2010 and are on the waiting list at the moment. The situation demands a careful revisiting of the programme and its future prospects. The academic committee at PICO did discuss the issue in its meeting while finalizing the admissions for 2010 and decided to wait and see for the trend among the candidates this year. Moreover, it was also decided that the issue shall also be discussed with all the stakeholders in future for suggestions and the students shall be counseled regularly to maintain their confidence in their future career as refractionists.

4.3 Working with the post-graduate College of Nursing

As per the mutual consensus, for the first time, the Ophthalmic Nursing Course was run jointly by PICO and the postgraduate College of Nursing, NWFP. The collaboration between PICO and the Postgraduate College of Nursing, NWFP is no doubt a historical event however initially PICO did not receive the required information about the admissions and year planner of ONC in time. The College was visited frequently by the faculty of PCVS and informal meetings were arranged were arranged with the Principal of the College to ensure collaboration. The students and the course coordinator were invited on a special occasion and the medical kits were given to them by representatives from our donors. The efforts did bring fruit as later, we developed a better and closer working relationship with the course faculty at the College.

46

4.4 Practical placement

The set up at the clinical department of Ophthalmology, HMC has changed in 2009. Now there are two units instead of the earlier single unit and OPD is run on daily basis. This has put an additional burden on service providers leaving very little time and opportunity for them to help the PCVS internees and other trainees learn the relevant skills. The situation demanded special attention and realizing the need for prompt action not only to ensure maintenance of a learning atmosphere but also to help the clinical department in service provision we reviewed the existing system of supervision. It was decided that the faculty of PCVS shall use the demonstration rooms at PICO more frequently and effectively. Secondly, they shall make frequent rounds to the clinical department to monitor the students and ensure their presence for the guidance of the students whenever needed. These steps did help the students in acquiring the relevant skills as majority of the students displayed a satisfactory level of skills in the final examination in spite of the short time for practical training this year. There was a general complaint from the internees and the 3rd year (BSc) students that they were not having a chance to learn contact lens practice at the clinical department. It was decided to make an alternate arrangement. Trial lens set only for the PCVS students was provided and the faculty members were allowed to bring the patients (needing contact lenses) to PCVS demonstration room where the students would assess the patient, fit the lens and educate the patient under their direct supervision. The above steps were implemented with the consensus and cooperation of the clinical department of Ophthalmology, HMC. An informal evaluation was done in the third week of June and some further minor modifications were made accordingly.

4.5 Disciplinary issues

It was noticed that some of the internees were very irregular in attending their duties. They were counseled many times by the faculty and issued warnings as well. The faculty finally decided that to ensure better discipline in future only those internees shall be allowed to take the final University examination who would pass the detention examination (special examination). All of the concerned internees passed the exam. Some of the trainee ophthalmic technicians displayed an unacceptably nonserious attitude towards the studies. They were counseled and at times given warnings and were fined as well. All except one finally responded positively by being regular and prepared for the assigned tasks. The case of the latter has been sent to the academic committee of PICO and cancellation of his course is under consideration. We realize that it would have been better to take the decision earlier. The faculty noticed that the use of cell phones during the study hours and even inside the classrooms was increasing to the extent that it was disturbing the learning environment. It was therefore decided to prohibit the use of cell phones 47

within the premises of the institution. In case of urgent need, the students were advised to attend the phone in the cafeteria.

4.6 Examinations

Team work can make it possible to perform challenging tasks successfully. The PCVS team members proved that when they conducted the following (11) examinations in a year: -BSc. 1st year (1st and 2nd semester) examination. -BSc. 2nd year (mid-term and final University) examination. -BSc. 3rd year (mid-term and final University) examination. -BSc. 4th year University examination -RTTC (mid-term and final University) examination -OTTC (1st semester, Medical Faculty) examination (exam is conducted by the faculty, students' registration and admission are sent by PCVS) -ONC final examination (faculty was involved as external examiner) The practical examination format was discussed with all the concerned examiners before the final examination. It was proposed by the faculty of PCVS to adopt TOACS from 2009 onwards to add more objectivity. All the examiners agreed and the new system was introduced. The students were also briefed about the new system. Though there was a lot of hard work involved but the exams went very smoothly, both the examiners and the students found the new system more effective, objective and fair. It was a learning experience as well and the faculty is very confident to conduct the exam even more effectively in future.

4.7 Accommodation for PCVS students

· The female students residing at the hostel (a house on rent near PICO) faced many problems including water shortage, security concerns, unsatisfactory hygienic etc. conditions that were solved urgently by PICO. Later, just before the final examinations, the owner asked to vacate the house on a short notice. It was very disturbing both for PICO and the students. However, the students were temporarily accommodated at PICO flats (basically for the visiting faculty). Meanwhile, another house on rent was arranged for the girls. The students were allowed to stay at the flats till the completion of their examinations to avoid any loss of precious time. The students are now in the process of shifting to the new accommodation near HMC. The problem is solved for the time being however, PICO management feels that the final resort would be an independent PICO hostel for the students.

·

·

4.8 PICO website

· This year, PICO website was very frequently used to disseminate information. The students of PCVS were also kept updated about their classes and examinations via the website. The admissions were advertised on the website along with the newspapers.

48

·

The merit and the waiting lists were also made available on the website. This proved to be very useful especially for the candidates belonging to places other than Peshawar.

4.9 Internees facilitating junior classes

· This year, the faculty of PCVS involved the internees in facilitating learning for junior classes under supervision. The results were very encouraging as the feedback from the juniors and the "student teachers" was very positive. This experiment also helped in enabling the students realize that they are a "team" and created a sense of ownership for their fellow students. We hope that the students shall take away the feeling as future professionals once they have completed their training, strengthening the eye care team.

·

4.10 Medical Faculty

· Our issues regarding OTTC management by the Medical Faculty, NWFP such as poor documentation and lack of sharing of the relevant information, late exams and declaration of results etc remained unresolved this year. We have planned to organize formal meetings with the Faculty to communicate our concerns and suggestions for a positive outcome.

49

Annual Project Report of PCVS 2009

5. Sustainability

· This year too like the previous one, PCVS remained self-sufficient in human resource. The faculty members were more confident in facilitating learning than the last year and did manage to complete the course work in spite of a shorter available time. The OTTC Diploma is now a 2- year Programme as prescribed by the Medical Faculty, NWFP but it is already being managed by completing the coursework in the 1st year, 2nd year is an internship at the deptts. Of Ophthalmology, district hospitals with no additional cost. The Ophthalmic Nursing course is now run jointly by PICO and the Postgraduate College of Nursing, NWFP hence the burden on our resources has decreased considerably. The admissions, most of the teaching and the conduct of examinations are all done by the College. The only financial inputs from PICO are in the form of medical kits. We have introduced RTTC -an additional programme in 2009 but it has been a financially feasible initiative as sufficient infrastructure for the new Diploma in refraction as well human resource is already available. The introduction of self-finance category led initially to the admission of 8 BSc. students in this category. Later, one of them was adjusted against the vacated sponsored seat in RTTC. The students paid an annual tuition fee of Rs. 40,000 and purchased their books and kits themselves. The tough competition for selffinance category for 2010 admissions is encouraging and 15 students have already accepted admission offer on self-finance basis. All the students are paying a monthly tuition fee of Rs. 500 since the last year. As decided earlier, the expenses of photocopying (teaching material) and the university examination and registration fees were all borne by the students. The medical kit has been revised. Certain items like overalls, files and pens are now not included in the kit. Though it is a small step but it is contributing to the long term sustainability of our programmes. Though we could not conduct short courses on dispensing optics, clinical refraction etc. as planned due to the very serious security concerns in the province but, we have not given up hope and shall be conducting these in 2010. The courses are expected to generate revenue for PICO. We encourage our students to apply for different academic scholarships as some of these include tuition fee that is paid directly to the institute. One of the students did secure such a scholarship by Higher Education Commission of Pakistan. 50

·

·

·

·

· · ·

·

·

Annual Project Report of PCVS 2009

6. Impact

· The Pakistan Centre for Vision Sciences, PICO has been able to produce a strong impact on the health care workers belonging to all carders on one hand and the community on the other hand. It has successfully sensitized all members of the eye care team at provincial and also the national levels. People trained at Pakistan Centre for Vision Sciences are assisting the ophthalmologists in providing eye care to the communities. Active involvement of the Mid Level Eye Care Personnel has strengthened all the eye health care activities. They are also involved in field surveys and eye camps and have proved to be a great help. Their most important role is eye health education that has definitely led to better level of awareness about eye health in the community. Another important impact that is yet evolving is in the form of the refraction services augmented by the trained refractionist of PCVS at the districts, both in private and public health sector. Many of the eye care professionals trained at PCVS are working with senior ophthalmologists at the private clinics not only ensuring better service delivery but also reflecting the success of our efforts towards building an eye care team. PICO has been doing advocacy for the creation of posts for the eye care professionals in the province. The impact of these efforts is evident by the information about the sanctioned posts (given in the table 1 and 2).

·

·

51

Name of post Refractionist Junior Ophthalmic Technician Total

No 2 11

BPS 9 9 13

Table 1: Sanctioned posts, Provincial and district level, 2008-09

Name of post Chief Oph. Technician Ophthalmic Technician Junior Oph. Technician Autoclave operator Total

No 3 1 12 2 18

BPS 16 12 9 8

Table 2: Sanctioned posts, Provincial and district level , 2007-08

· Realizing the dire need of our communities for female eye care professionals, we have been focusing the potential female candidates while marketing our courses. The gender-wise distribution reached to 50% for each gender in 2008 which was a great impact of our struggle. The number of female students dropped in 2009 (Table 3)but we hope that it is transient set back that we can quite confidently attribute to the adverse security circumstances in many districts of NWFP that could not allow girls to seek education at Peshawar.

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S. No

1 2 3 4 5 6 7 8 9

Session

2001-002 2002-003 2003-004 2004-005

Males

11 12 9 13 16 15 13 16 105

Females

0 1 1 0 3 8 13 6 32

*2006

2007 2008 2009 Total

Table 3: Gender-wise distribution of students

From 2006 onwards it was decided that the academic sessions shall begin in January and end in December of the same year instead of October to October of the next year as in previous years.

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Project Report of PCVS 2009

7. Progress towards Project Purpose and overall organizational Aims

PCVS has continuously progressed towards the over all organizational goal as it has played a vital role in providing high quality affordable and sustainable comprehensive eye care through an integrated effort in areas of HRD, infrastructure development, research and total quality management.

8. Other factors that have affected / may affect the project

· The formal status of PICO shall be defined in 2010. It is expected to be given the status of an autonomous institute working under the Department of Health, NWFP or HMC. Once this is declared by the government, it will motivate its staff owing to the perceived job security afterwards and also attract more students. The confidence of other stakeholders including our international partners in investing in our programmes is likely to increase. A well defined status is ultimately going to help us in becoming a sustainable institute. The security circumstances that have been deteriorating in Pakistan, particularly in NWFP, unfortunately worsened in 2009. The students from the sensitive areas were adversely affected by these, some of them became IDPs! Students were also sent on a break on the orders of the provincial government for about 3 monthsleaving behind very little time for practical placement. We hope that 2010 shall bring peace to the province but at the same time we do realize that the security situation may take a couple of years to normalize and are prepared for tough time ahead. Unfortunately, the financial crisis in the country as else where continues. Being a developing country, it is expected to take more time to get out of the recession. The retention of the faculty and the affordability of the expenses for the students shall therefore persist as challenges in the coming year too.

·

·

·

9. Planned Activities and Milestones

The master year planner for 2010 is attached with the report as annexure II. The KPI tables are given as annexure III.

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Annual Project Report 2009

10. Recommendations

10.1) It is recommended that a comprehensive strategy may be devised to promote RTTC. The growing need for trained refractionists in the country justifies such efforts. Moreover, PICO needs to advocate for the creation of new posts for district refractionists by the government. This shall be an incentive for the students to join the course. 10.2) The report also recommends that frequent and effective communications between the faculty of PCVS and that of the Postgraduate College of Nursing are ensured in future as well so that the experience of working together brings positive outcomes and improvement in the quality of teaching and training on the course. 10.3) It is strongly recommended to review the current experience of practical placement of the internees and identify the gaps. The internees of 2010 should be monitored very closely and their presence at the assigned clinical stations and the acquisition of the relevant clinical skills should be ensured. 10.4) It is suggested that the internees may be placed at different CVCs in the province. However, the first quarter should be spent at the deptt. of Ophthalmology, HMC under close supervision of the faculty. Later, if placed at CVC, even then, the internee should work under supervision. The supervisor should provide quarterly feedback about his/her performance to PICO. 10.5) The experience of class facilitation by the internees (for juniors under the supervision of the faculty) has added value to the programmes and it is recommended to continue this practice in future. Moreover, it is also suggested that the internees should also have regular sessions on clinical diagnosis and management by senior ophthalmologist in order to further polish their skills. The latter is likely to create a bonding between the ophthalmologists and the other eye care professionals which is vital to the concept of an eye care team. 10.6) As the students are not being allowed any recreational trips, it is recommended to arrange alternative events to refresh them such as sports and competitions (debates, declamations, quizzes, poetry etc). The students should be encouraged to participate and give their feedback and suggestions. The promotion of co-curricular activities shall create a healthier learning environment for the students. 10.7) Owing to the security risks in the province, it is strongly recommended to strictly follow the existing security protocol at PICO and take further steps to ensure that irrelevant people are not allowed to enter the institute. 10.8) The feedback from the faculty of PCVS supports the policy of "no mobile phones within the premises of the institution" hence it may be continued. 10.9) It is strongly recommended to ensure discipline among all the students so that they prove to be responsible professionals in future. 10.10) It is emphasized that PICO should conduct short courses on dispensing optics, mobility and orientation training etc. as a strategy towards sustainability. 55

10.11) It is very strongly recommended that PICO shall explore all the resources in order to establish its own, independent hostel for the students. 10.12) Once again it is recommended to move forwards to introduce a Master Programme in Vision Sciences necessary for the capacity building of the potential candidates. 10.13) It is suggested that a research study regarding the impact of the MLECP trained at PCVS including the patients' perspective may be conducted this year. 10.14) PICO is to undergo an organizational assessment (all stakeholders have agreed in principle). The institute is in the process of finalizing the TORs. It is recommended to accelerate the process so that the evaluation is carried out earlier in 2010. The recommendations of this evaluation could prove vital for the quality assurance and sustainability of the institute. 10.15) It is recommended that organized efforts are made to resolve the issues of concerns regarding the management of OTTC by the Medical Faculty, NWFP. 10.16) last but not the least, it is recommended that the students should have regular sessions on medical ethics so that the HR we produce is not only equipped with the relevant knowledge and skills but also the right attitude.

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11.

SPECIAL EVENTS AND CASE STUDIES OF 2009

11.1 World Sight Day held at PICO

This year too, keeping the tradition alive, Hayatabad Medical Complex held the World Sight Day on 8th October by arranging a special Programme at PICO. High officials from the government sector including the Provincial Secretary health who was the honorable chief guest, representatives from international, national and local stakeholders, representatives from three teaching (tertiary care) hospitals of Peshawar, representatives from the Khyber Medical University, PGMI and Post-graduate College of Nursing and students of PICO also attended this occasion. The speakers emphasized and highlighted the importance of the World Sight Day and gender equity in eye care in particular. Medical kits were also distributed among the BSc students on this occasion.

11.2 Internees in action!

Vision Screening Of Children At Special Education School, (Association For Rehabilitation Of Physically Disabled -ARPD Umaid Abad, Swati Gate Peshawar).

CHEF International requested PICO to assist them in performing the vision screening of children at Association for Rehabilitation of Physically Disabled (ARPD) Umaid Abad Swati Gate Peshawar School. In response to their request, on Monday, 9th February 2009 a team headed by Mr. Samiuddin, Lecturer and coordinator- PCVS and Miss Rubina, coordinator of CHEF International visited the school and made prior communication with head of the school and devised a plan for screening with mutual consensus. Over the next two days, the team from PCVS including the faculty and internees carried out the visual assessment of all the children at the school and recorded the findings on a proforma.

57

s

Group photo of students and the survey team The output of the activity was as follows:

Students waiting for their turn

1. Total no of students and staff screened =57 2. Two students and five teachers needed spectacles 3. One child needed referral. Prompt actions were taken on the basis of these findings. It was not only a learning opportunity for the internees but also a great help to the students of the school.

Screening process underway

Senior students teach juniors!

Teaching and training is one of the important tasks that health professionals have to perform in their professional career. Realizing the fact, for the first time, the internees were involved in facilitating classes (under supervision) for the 2nd year and 3rd year BSc. students. The internees were given specific topics to prepare for the lectures and sufficient time. The experience was a huge success as both the internees and the junior students gave a very positive feedback. 58

The internees stated it be an opportunity to upgrade their knowledge and communication skills and enhance their confidence while the junior students found the lectures very useful and student friendly. An important aspect of this initiative was that the concept and the feeling of being a member of the eye A future teacher in action care team, irrespective of the level of the students was practically displayed. The juniors arranged a party to thank their seniors for their honest and brilliant efforts. It has created a very friendly learning environment. The faculty members of PCVS who supervised the internees were very pleased with the quality of their lectures and the handouts they provided for the juniors. The practice shall be continued as all the stakeholders demanded so.

Participation in free eye camp organized by Overseas Pakistanis Foundation (OPF)

PCVS internees participated in a four-day free eye camp at district Swabi. It was an opportunity for them to actually work in a community setting and at the same time they provided the much needed services.

The team and the community

59

Screening services to IDPs at Kacha Gharhi and Jalozai camps

Human Resource Development Society (RDS) is a local NGO who took the initiative of conducting screening for refractive errors and other eye disorders among the IDPs at the Kacha Ghari and Jalozai camps. They were seeking HR support and SSI facilitated the process by introducing PICO to them. Later, the two organizations agreed that PICO shall provide HR (PCVS, internees) for the said purpose. We are pleased that our internees carried out the screening for refractive error at the camps for about five weeks very efficiently and effectively. In fact, IDPs with other problems also expected help hence they also screened many subjects for other eye diseases and managed them accordingly.

Yes we can! A confident internee poses in front of the camp

60

1.3 PCVS faculty members in Zambia

SSI took the initiative of school screening for refractive error in Zambia and contacted PICO to involve the faculty members of PCVS in the screening. Mr. Imran Jan and Mr. Samiuddin (faculty members of PCVS), were nominated for the said venture. They were sent to Zambia by SSI and stayed there for about three months where they conducted school screening for refractive errors. We are proud of them as they did the job professionally and won a good name not only for PICO but for the country.

Bringing Asia and Africa together through eye health services!

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11.4 CASE STUDIES The success story of Mr. Siraj Khan Safi

Mr. Siraj Khan, a former student of PCVS, PICO, secured his BSc. Vision Sciences (Orthoptics) degree in 2007. He has been working with us since 1997, initially as an ophthalmic technician. Till 2009 he was actively involved in academic and other project activities along with the clinical management of patients at the orthoptic clinic, HMC. PICO first nominated him for 6-month training in advanced orthoptics at Sri Lanka and then this year he was sent to Mr. Siraj Khan Alder Hey Children's NHS Foundation Trust, an Orthoptist and UK for a three month hands on training in a poet advanced Orthoptics. FHF had sponsored his visit. He has walked a long way beginning as a young ophthalmic technician to a polished orthoptist. Mr. Siraj is the first eye care professional in the province who has been selected as an orthoptist against BSP 16 at a tertiary care hospital i.e; Hayatabad Medical Complex in December, 2009. He has joined his new job. We wish him all the best in future and at the same time feel proud that our efforts regarding the training of eye care professionals and advocacy for their subsequent career structure are becoming evident now.

Mr. Masood Jan, a valuable team member

Mr. Masood Jan has been working at PCVS, PICO as an instructor since 2006. He is a patient of low vision himself. The conducive environment at our institute has enabled him to contribute very positively towards the institute as well the community. He was sent for training in mobility and orientation earlier. Masood is also a brilliant Cricketer of international caliber. CHEF International requested to allow him to help them in Braille printing of school syllabus books for the visually impaired. PICO relieved him for about three months for the said purpose. The task has now been almost completed. No doubt, it is a great job done! Masood is an example for those who want to contribute to their communities irrespective of the existing barriers.

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From Cricket to Braille printing

Mr. Fahim ur Rahman -former PCVS student wins HEC scholarship for a PhD in Vision Sciences

Mr. Fahim ur Rahman Mr. Fahim ur Rahman has completed his BSc. Vision Sciences in 2008. KMU had advertised HEC scholarships for PhD in UK including one scholarship for Vision Sciences. Many former students of PCVS applied for the latter, Mr. Fahim finally secured the scholarship after a tough competition. He has already been given an admission offer form Leicester University UK. We congratulate him for being the first ever optometrist from Pakistan going for a PhD. We also thankful to Prof. Shad Muhammad (now Director Academics and Quality Assurance, KMU) who has made it possible to reserve one scholarship for the Vision Sciences students in spite of many barriers.

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