Spectacles : Symbol of disparity?

In 2001, the International Centre of Eye Health, an affiliate of London School of Hygiene and Tropical Medicine carried out a countrywide joint survey with the National Institute of Ophthalmology, Bangladesh. The results of the survey were alarming. The survey revealed that 16.4 percent of the Bangladeshi adults -- both men and women -- who are over 30 years of age, regardless of whether they are from villages or cities, have defective eyesight (refractive error). This means about 3.3 million people have a problem with their eyesight (

Expensive and time consuming
The general process of taking up glasses in Bangladesh is time-consuming and expensive. If one feels the need of glasses, he has to go the ophthalmologist. They are the only ones who can give you prescription for your spectacles. Being able to consult eye specialists at the outdoors of government hospitals can be considered a stroke of fortune. So one is forced to visit the doctors who have their chambers in the flashy outlets making and selling the spectacles. After paying Tk 200 to 500 to the doctor, it is time to order your glasses. The seasoned salesman will talk to the patient into ordering a spectacle that could be priced at anything ranging from five hundred to five thousand.

Once the order is made, the customer has to come a second time to get his glasses. This means that the doctor's fees, the price of glasses, and the transportation cost for the two days would make a total of at least eight hundred to one thousand taka. For an average man, especially the poor, and particularly a woman, it is not possible to pay that much money or find out free time on two different days. This is how the spectacle becomes a symbol of affluence, and a symbol of economic disparity.

Not easily available for the poor and women
In 2003, Bangladesh National Institute of Ophthalmology, ORBIS and Sight Savers International carried out a joint survey and found out that there are 626 ophthalmologists in Bangladesh. Of them, two-thirds practice either in Dhaka or in the other divisional cities. Many districts do not have any eye specialist. This means that people in those districts wanting to take up spectacles have to travel away to other districts, and for that they need someone to accompany them, as they cannot see properly. Similarly, a woman cannot travel outside her village or district on her own. To stay away from home for two days, she has to have a relative's place to stay in that town. Thus it is not always possible for someone, especially a woman, even if she can afford, to arrange all these to take up glasses.

Paramedics can provide it
To make spectacles affordable and available to all is not a Herculean task. As opposed to Tk 500 to 5,000 and a two days stay away, it is possible to get glasses at people's doorsteps at a much cheaper rate of Tk 50 to 100.

In countries neighbouring Bangladesh, like India, Nepal, Pakistan, and also USA and Great Britain, the ophthalmologists do not prescribe spectacles; rather paramedic level professionals named Optometrists do. The Indians have had this course running for the last thirty years. The paramedics are not as famous or expensive as the doctors or the specialists. After passing the tenth or twelfth grade, the paramedics or optometrists can take up a two-year-long diploma course. Once that is complete, they are qualified to prescribe for spectacles at a low price. And as there are more paramedics than doctors, they can work in villages; that is, not only can they serve the district towns, but also at a lower level. If the system is arranged in Bangladesh, the problems faced by people to whom glasses are not available will soon be solved. As the paramedics would not be as highly qualified, they could give their services and sell glasses at very affordable rate of ten to thirty taka. However, in the name of quality control and ensuring proper cure, our ophthalmologists have opposed such proposals in the past, and may do so in the future.

Duty of Health Ministry
None of our personalities in position took the initiative to start an optometry course in Bangladesh. There is also no sign that the government would take up such a step in the near future. So for the greater benefit of the masses, I appeal to the civil society to come forward and raise following demands to our Health Ministry:

1) Immediately start one- or two-year-long courses of optometry.

2) The government-run paramedical institutes should provide these courses, and thus create jobs for thousands of our unemployed youth.

3) The Health Ministry should permit private universities to start this course competitively, and should make the related rules more flexible. Health Minister is there to help the country and its people, and not to protect the private practices of the doctors.

4) The various banks, especially Grameen Bank and BRAC, should allow their clients long-term student loans, without any collateral, for their members' sons and daughters, so that they could take up these courses. Therefore, once they have completed the courses they can go back to their villages and serve the people.

5) Every year Lion's Club, the Rotary Club and other similar organisations spend a lot of money on various eye related activities. A portion of it can be used to finance a student taking up optometry; s/he can be then given the responsibility of eye care in his/her own locality.

Follow the cheap Chinese method
The price of glasses in Bangladesh is needlessly high. The technology of lenses is not a rocket science. A plain glass can be turned into a powered lens, and can then trimmed and sized accordingly to fit into a plastic or celluloid frame. In village fanfares, colorful plastic sunglasses costing Tk 2 to 10 are sold to young children. The production cost of making glasses for adults, with powered lenses, can be kept within Tk 50. Recently, reading glasses, with transparent plastic lens (not plain, with readymade power), have been made available for sale in spectacles shops: they are Chinese and cost Tk 125 to 150. The production cost in the Chinese factories is below Tk 20. From this information it is clear that the spectacle business in Bangladesh has a cartel. If glasses can be made available everywhere to whoever shall need them, then this cartel will break or at least be not as effective.

Dr. Md. Khairul Islam is the country director of ORBIS International, Bangladesh. However, the views expressed are his personal, not of ORBIS.