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Mobilizing the Community to Eliminate Preventable Blindness in Children

Recognizing myopia as a public health problem, the Chinese Government launched a comprehensive national plan for the prevention and control of myopia. Village doctors like Pan Taoling have a large role to play in achieving the government’s goals.

Vision loss is an important public health and socioeconomic issue that affects economic and educational opportunities and reduces quality of life. As the most populous country in the world, China has an enormous number of people with moderate-to-severe vision impairment or blindness.

This includes millions of children across China with uncorrected vision impairment, especially in rural areas, where the prevalence of myopia—the most common eye disorder and leading cause of visual impairment and blindness in children worldwide—is alarmingly high and access to an eye doctor is low. Children developing vision problems are often taken to a local private eyeglasses shop, which may not have the capacity to provide quality eye care services to children. As a result, many children with myopia remain untreated or inadequately treated.

Recognizing myopia as a public health problem, the Chinese Government launched a comprehensive national plan in 2018 for the prevention and control of myopia among children and adolescents which involves collective societal action at all levels. Village doctors—community health workers linking communities to formal health systems—have traditionally played an important role in China’s rural health and have a large role to play in achieving the government’s goals.

Village doctors play an important role in China’s rural health.

For the last 14 years, Pan Taoling has been a village doctor in charge of child health at Shuige Village Clinic, Luliang County in Yunnan province, which is among the provinces in China worst affected by myopia. Taoling is responsible for managing the healthy development of children, including their eye health.

Since 2019, Johnson & Johnson Foundation has supported the government’s efforts by partnering with Fred Hollows Foundation on a multi-pronged approach to tackle the prevalence of myopia in Yunnan province and addressing the gaps in health service skills. This includes screening children in primary schools, providing eye health education to students, teachers and parents, and training community health workers like Taoling to monitor and refer children with problems to be examined by eye doctors in township health centers.

“As village doctors, we are mainly responsible for coordinating and convening relevant people to participate,” says Taoling. “The basic eye care knowledge and skills training provided by the Fred Hollows Foundation has helped us a lot. Some eye diseases we didn't know before were also known through training, and we can make timely referrals when we find such cases. After screening, we will know which children in our village have vision problems, and we will mobilize their adults to take the child to the county hospital for further examination.”

The high rates of vision problems are attributed to poor knowledge of myopia, its prevention and its management. Other factors include social stigma, prejudice and discrimination around wearing spectacles. The issues are made even worse by urban migration, which typically means rural school-aged children are left with aging grandparents who keep them indoors more often than previous generations.

“Nowadays, when the adults are busy, they give their mobile phones to their kids or let them watch TV,” explains Taoling . “It can impact their eyes. I always remind those adults to get the kids go out and play more.” Some villagers resist regular medical examinations and that can also be challenging, she adds. “I wish everyone would listen more to our suggestions and cooperate with the medical examination work. This is actually good for them.”

On the whole, Taoling is pleased with the work being done by the Fred Hollows Foundation in her village. “Through our joint efforts, the eye health status of the children in our village has been well understood. Families who need further examination or treatment can see a doctor in time with our mobilization, so I feel my work of child health management is very valuable and important.”

Her days, she says, are also filled with many moving moments. Taoling recalls referring the parents of a newborn experiencing discomfort caused by a blocked tear duct to an upper-level hospital. “They came back when the baby was healed to thank me. I am helping parents find health problems in time, and make timely referrals and treatments. The most encouraging thing is to see a newborn baby looking healthy, that makes my heart feel very warm and happy.”