Corruption and pilferage are the biggest threat to the effectiveness of the medical supplies distribution to the underprivileged people. Some spurious charity organizations take the funding and never do the intended work or pilfer the products and sell them to the wealthy customers for healthy profits
This solution is unique and scalable: The solution is to create a human chain using block chain concepts along with the distribution model of a courier delivery services. The concept includes the integration of process, people, technology and auditing as described below
Step-1: Verify the Need – Use corporate CSR teams/ Medical research facilities to verify the need highlighted by the requestor (block chain concept)
Step -2: Pre-identify the beneficiaries. Issue a handheld device or develop an app based on the mobile phone (to be developed as part of the HCDS initiative, along the lines of courier delivery tracking device) to the requester to produce the data base of proposed beneficiaries (finger prints, pre-diagnosis, healthcare prescription). The information to be stored in a centralized application/ tool (to be developed as part of HCDS initiative.) As the programme develops, this data can be globally collected and managed
Step-3: Funding grants to be released in steps. Disburse the healthcare product/ services in stages and seek delivery proof for each stage by using the same handheld device. The next stage of grant/ medicines to be released on producing evidence of disbursement (finger print or bio-records) for the previous stages
Step-4: Random Audit. The diagnosis, beneficiary, diagnosis and impact data can be audited randomly at a predetermined frequency. Corporate CSR teams/ Medical research labs can be picked randomly to conduct audit on part/ whole of the transaction using the disbursement and delivery data
“Anti-tuberculous therapy in a real-life clinical setting significantly reduced the number of flare-ups and enabled long-term remission in patients with presumed ocular tuberculosis.”
Tuberculosis (TB) remains a global health challenge: The World Health Organization (WHO) estimates that 10.4 million cases and 1.3 million deaths were recorded worldwide in 2016. And although Mycobacterium tuberculosis typically affects pulmonary tissue, the infection may present a myriad of extra-pulmonary manifestations. Intraocular tuberculosis presenting as posterior uveitis may be difficult to recognize by physicians working outside TB-endemic countries, as it mimics a variety of uveitis entities.
Currently, there are no standardized diagnostic criteria for ocular tuberculosis. Instead, confirmation relies on known clinical symptoms’ patterns, tuberculin skin testing and culture, or DNA PCR of MTB in intraocular samples. Interferon gamma release assays (IGRA) are highly specific for MTB infection, but cannot differentiate between latent and active tuberculosis, thereby worsening the controversy.
“While ocular TB, a recognized form of extra-pulmonary TB, is associated with high rates of morbidity, there is little clinical information or standard guidelines for its diagnosis,” shared Dr. Rupesh Agrawal, Adjunct Assistant Professor and Consultant Ophthalmologist, National Healthcare Group Eye Institute NHGEI), Tan Tock Seng Hospital (TTSH), Singapore, shedding light on the ocular TB dilemma. The absence of a unified guide thus poses a challenge in the diagnosis and management of the disease, emphasized Dr. Agrawal.
The Collaborative Ocular Tuberculosis Study (COTS), a first-of-its-kind, multicenter global initiative, according to Dr. Agarwal, was established to address the challenges ocular TB care faces via cloud computing and big data.
Open globe injuries present an ophthalmologist with management dilemmas with many unresolved controversies. The visual prognosis at presentation is often difficult to assess in the vast majority of injuries leading to primary repair. Multiple intraocular surgical procedures may be needed on such eyes in an attempt to salvage some useful vision. We have come a long way in the field of ophthalmology from intracapsular cataract surgery to femtosecond refractive surgery and from subjective macular assessment to Fourier domain and adaptive optics imaging of the macula. Likewise, we are in the era of ocular nanotechnology and its application in ocular pathologies. The results of globe injuries have improved with better understanding of complications and improvement in techniques of vitrectomy, however, still many eyes still end up in poor vision. Despite all the work and efforts of key players in the field of ocular trauma, it still searches for recognition and identity as a subspeciality. Not many ophthalmologists are familiar with the terminology of ocular trauma and still reckon Ocular Trauma Score as a research tool and the eye injury registry is most ignored and neglected part in the clinics. With the basic understanding of eyes with open globe injuries and following the concepts of ocular trauma repair, we can prevent significant ocular morbidity due to this devastating entity. Concept of atraumatic repair needs to be ingrained into strategic planning in ocular trauma management to achieve optimal outcome in globe trauma. Multidisciplinary approach is warranted in patients with complex ocular trauma. Empowering the fellow ophthalmologists with specialty training in ocular trauma can be one of the steps forward in optimizing the outcome in patients with ocular trauma and further streamlining the care of traumatized eyes. Medicolegal litigation can be minimized by good documentation, establishing rapport with the patient and family and following the basic principles in management of ocular trauma.
Five-year view: One of the most neglected parts in ocular trauma management is very weak epidemiological data. Every attempt should be made by the local and national societies to mandate the reporting of eyes with Open Globe Injuries, if not all eyes with ocular trauma under common local registry. Further attempts should be made to link the local registry with the state and national registry, which should be eventually linked to the international registry of ocular trauma. The epidemiologic data hence generated will guide us about the impact and burden of this problem and in terms of health economics research will pave the way for boosting up healthcare policy and resources to prevent this gigantic but preventable cause of blindness. It will also highlight any obvious regional and national causes and safety tools than can be devised accordingly. Training of junior ophthalmologists in management of ocular trauma along with training in cataract should be part of the curriculum and the trainees should be given exposure in theatres or use of wet labs. Unsupervised repair of the traumatized eyes by inexperienced surgeons should be strongly discouraged and every attempt should be made to transfer the surgical skills to the novice surgeon by more experienced surgeon. Likewise, prospective multicenter studies need to be conducted to further investigate the prognostic factors in Open Globe Injuries and to revisit classification of ocular trauma and Ocular Trauma Score and to redefine some of these parameters based on the analysis and outcome of prospective multicenter studies. A strong emphasis on preventative aspects should be the major goal in the next 5 years and this may involve closely working with regulatory authorities in healthcare planning.