Karachi: Marine fishing is one of the world’s most dangerous occupations. Conducting health research within these communities can be time-consuming, expensive and unpredictable given that most men are at sea for lengthy periods and women may be reluctant to participate.
Over the last seven years, Dr Khabir Ahmad, associate professor of ophthalmology at the Aga Khan University, has taken on this exacting task and managed to collate robust evidence on how groups within these communities – the elderly and women – are at a disadvantage even when they are provided access to care.
[junkie-alert style=”white”] Dr Khabir Ahmad advocates for healthcare ‘rights’ of the city’s indigenous fisheries communities, based on the Karachi Marine Fishing Communities Eye and General Health Survey. [/junkie-alert]
“The fishing communities of Karachi and their cultures are extremely unique,” Dr Ahmad said while describing the milieu, “but abject poverty, illiteracy and negligible political representation means these communities remain on the fringes – overlooked and unheard in mainstream discourse.”
Dr Ahmad conducted the Eye Survey on three islands and in four coastal neighbourhoods of Karachi. Most of these areas house three major ethnic marine fishing communities, the Kutchi, Bengali and Sindhi who have seen little to no change in their way of life.
Dr Ahmad and his team interviewed and examined nearly 640 individuals 50 years and above. Data was collected on gender, ethnic and socioeconomic differences in access to eye care services, outcomes of eye surgery (cataracts) and the economic and social cost of vision loss.
The survey found that 94% of the elderly lived in extreme poverty, 84% had no school-based education and 55% had never had an eye examination. Cataract and refractive errors (optical problems that cause blurred vision) were the leading causes of vision loss even though both are curable.
Of the three ethnicities, Bengalis were four times less likely to have had an eye examination in the past than Kutchis and Sindhis, and were more likely to cite financial hardships as barriers to eye care. This reflects on the poor assimilation of Bengali migrants, who had come to Pakistan following the breakup in the 1970s.
Another striking finding was that women had markedly more vision loss than men. Of those who had undergone cataract surgery in one or both eyes, women were substantially more likely to have poorer outcomes compared to the men.
“Women were more likely to cite financial hardships, “fears” and social support constraints than men in accessing health care,” said Dr Ahmad.
This survey was under the supervision of Dr Anthony Zwi, Professor of Global Health and Development, Faculty of Arts and Social Sciences, University of New South Wales, Australia. Dr Zwi, known globally for his advocacy and research work in indigenous and aboriginal communities in Australia and the Pacific, says that identifying communities with poor health and high levels of inequality and inequity in health outcomes should drive us to focus more on these groups.
“The World Health Organization’s ‘Vision 2020: The right to sight’ and the post-2015 agenda specifically argues that ‘no-one should be left behind’. Our data highlights yet another group of people who warrant increased attention and engagement with promoting their health,” Dr Zwi elaborated.
Over time, Dr Ahmad says that the scope of the project widened: “In the beginning it was data collection, but as we met these communities we started identifying people who needed referrals, providing on-the-spot treatment and even handing out prescription glasses. At times we would ferry 20-25 patients for corrective surgeries.”
A key outcome has been winning the trust of community members. “The community, especially the women, were scared of getting operated. One woman told us that she left the village when we came. Once they saw the outcomes, their trust built up and they became comfortable with us.”
“For our upcoming research projects, we will explore whether the poor outcomes post-surgery are due to advanced stage cataracts or the quality of surgeries,” said Dr Ahmad. “We should have a commitment to eliminate avoidable blindness.”
The survey, made possible by a scholarship from The Fred Hollows Foundation, Australia, earned to Dr Ahmad a PhD from the University of New South Wales, Australia.