In 19__, my father, Dr. Amin El Maghraby, founded the El Maghraby Eye Hospital in Jeddah, Saudi Arabia. From this early development, we expanded to meet the need for eye care in our region in a way that would be more permanent and self-sustaining. The centerpiece of our efforts to establish a permanent infrastructure for eye care in the Middle East was the establishment of Al Noor Eye Foundation for the Prevention of Blindness in the Middle East in 1989.
The mission of the Foundation is to develop sight restoration and blindness prevention programs in Africa, the Middle East, and Asia. Since 1991, over 60 eye camps have been organized by Al Noor Staff and volunteers in 17 African countries. From these early efforts, we expanded to meet the need for eye care in our region in a way that would be more permanent and self-sustaining.
We set up non-profit eye hospitals and centers in Africa and Asia, where treatment and surgery are available for poor patients free of charge and we regularly donate essential ophthalmic equipment to eye care facilities which otherwise would not be able to afford this technology. Since 19__, the Al Noor Foundation has supported the growth of __ state-of-the-art eye care facilities in __ countries, providing --,--- surgeries per year along with --.---- outpatient exams and treatments.
Al Noors current focus is Egypt where we have recently established the largest eye hospital in the Middle East. The new facility is dedicated to a community-oriented public-health approach that delivers eye care to the poor. The hospital is a state of-the-art facility, providing quality eye care to all Egyptians and training to eye care personnel from Africa and the Middle East. Its operations include all subspecialties of ophthalmology, nine operating theaters, eighteen examination rooms, and a low vision clinic.
The hospital is developing a high volume, low cost approach to eye care delivery that is financially self-sustaining yet remains oriented to the poor. Eye care services are designed to be affordable and accessible to all economic strata, including services provided at no charge to those who are too poor to pay. Outreach and social marketing programs are currently under design to reach and motivate the poor to come for eye care service, particularly for people afflicted with cataract.
This involves collaboration with community organizations to conduct diagnostic screening camps in villages to identify those in need of surgery or treatment and door to door case finding at the village level. Public awareness campaigns are being designed to make people aware of prevention of eye disease and the availability of services.
The Al Noor Foundation is committed to developing eye care programs that are financially self-sustaining, affordable and accessible to all regardless of ability to pay. Increasingly, eye programs in Africa and Asia are developing self-financing mechanisms that lead to financial independence while providing services to the poor.
These programs focus on improving quality to increase market demand and enhance surgical productivity to significantly decrease per unit surgical costs. Through careful research, they have gained an understanding of the local peoples' capacity to pay and have priced their service to be affordable to rich and poor alike. The hallmark of these self-sustaining programs is the choice to use profit and production capacity for service delivery to everyone, including the poor.
In spite of considerable progress by national blindness prevention programs, in many countries the number of blind and visually impaired people continues to rise, mainly because of population growth and the increase in life expectancy. The most recent estimates of the World Health Organization (WHO) state figures of 45 million blind and 135 million visually impaired people. Approximately 50 per cent of the world's blind suffer from cataract. The majority of the remaining persons are blind from conditions that include, among others, glaucoma, trachoma, onchocerciasis (also known as river blindness) and different conditions of childhood blindness.
According to World Health Organization estimates, approximately 80 per cent of these people need not to be blind, since their blindness is either curable or could have been prevented if the available knowledge and interventions had been timely applied.
The burden of blindness causing conditions is felt most heavily in developing countries, where the majority of the affected people live. These are the very parts of the world least prepared to address these problems. If additional resources are not urgently mobilized and efforts are not made to curb trends in eye disease, by 2020 the global burden of blindness can double. The developing countries will bear the brunt.
The Al Noor Foundation, formerly Saudi Eye Foundation, was established in 1989 and is based at the El-Maghraby Eye Hospital, Jeddah, Saudi Arabia and at the El-Maghraby Eye Institute, Cairo, Egypt. The mission of the Foundation is to develop sight restoration and blindness prevention programs in Africa, the Middle East and Asia.
The main objectives of the Foundation are to:
-Develop innovative service delivery models that make quality eye care affordable and accessible to all economic strata.
-Develop primary, secondary and tertiary eye care centers in areas of great need
-Provide affordable ophthalmic technology for developing countries.
-Promote basic, clinical and epidemiological ophthalmic research as a basis for developing appropriate blindness prevention strategies.
-Develop training programs in ophthalmology which include: residency; post graduate fellowship; short term surgical training; continuing medical education; and training for technicians, nurses and managers.
-Initiate and implement policies for the prevention of blindness in the Arab world, Africa and developing countries, in collaboration with health ministries and ophthalmic societies.
-Provide education and public awareness about prevention and treatment of eye disease.
-Organize and support symposia, conferences and congresses.
Activities And Accomplishments
El-Maghraby Eye Institute, Cairo, Egypt
Al Noor provides extensive financial and technical support to the El-Maghraby Eye Institute, Cairo, Egypt. The Institute was established to honor the memory of Dr. Amin El Maghraby and became operational in 2000. The Institute provides quality eye care to all Egyptians and training to eye care personnel from Africa and the Middle East. The Institutes physical plant encompasses a 120,000 square feet state of the art eye hospital and training facility and includes nine operating theaters, eighteen examination rooms, eighteen examination rooms, and a low vision clinic.
A service delivery model is being developed for the hospital which makes eye care affordable and accessible to all economic strata. All subspecialty services, including low vision, are provided. Outreach and social marketing programs have been designed to reach and motivate the poor to come for eye care service, particularly for people afflicted with cataract, this being the major cause of blindness in Egypt.
Establishment of a high volume service delivery model is essential to bring down the cost of eye care to make it affordable for the poor and to provide a sufficient patient population to conduct training programs to develop the skills and knowledge of ophthalmic personnel. A network is being developed with local non-governmental organizations, community leaders, and international partners to implement this approach.
Secondary eye care hospitals
Al Noor has supported the development of the following eye care centers with start-up funds, technical expertise and ongoing operating costs:
El-Maghraby Charitable Eye Hospital, Khartoum, Sudan.
El-Maghraby Charitable Eye Center, Kadabas, Sudan
El-Maghraby Charitable Eye Hospital, Dhaka, Bangladesh.
Islamic Eye Center, Sindh, Pakistan.
Al Thawra Hospital Eye Center, Sanaa, Yemen
Karachi Eye Hospital, Karachi, Pakistan
Al Noor also provides substantial support each year towards provision of free tertiary care services and surgery to patients at the El-Maghraby Eye Hospital in Jeddah, and to other eye centers. From 1989 onwards, over 26,000 patients have benefited form services and 3,000 have received surgery at not charge.
Mobile services in Africa
Since 1991, over 60 eye camps have been organized by Al Noor Staff and volunteers in 17 African countries: Tanzania, Sudan, Mauritania, Niger, Djibouti, Eritrea, The Gambia, Sierra Leone, Burkina Faso, Chad, Somali, Mali, Kenya, Senegal, Uganda, Cameroon and Nigeria. Over 252, 077 patients have been examined; 20,522 sight restoring surgeries performed; and 63,913 glasses prescribed and dispensed.
Through collaboration with Tissue Banks International and Al Noor Foundation, International Federation of Eye Banks (IFEB) was initiated and established. IFEB has grown to the largest group of eye banks worldwide, providing corneal tissue according to the highest quality control standards.
Eye banks receiving support for their start-up include: Ain Shams Eye Bank and Kasr Al-Ainy Eye Bank Cairo, Egypt; Khartoum Eye Bank, Sudan; Chittagong, Bangladesh; Myanmar; Nepal; Colombo, Sri Lanka; India (Hyderabad, Ahmedabad, Bombay); Beirut, Lebanon; Damascus, Syria, Morocco and others for a total of 18 eye banks presently operational . These eye banks provide an average of 8,000 corneas per year to combat corneal blindness, a formidable accomplishment, particularly in countries where religious and cultural barriers to obtaining tissue had to be overcome.
Pan Arab African Council of Ophthalmology (PAACO)
Al Noor Foundation spearheaded the development of the Pan Arab African Council of Ophthalmology (PAACO) to unite ophthalmologists and ophthalmic societies throughout the Middle East and Africa. The mission of the council is to strengthen the relationship of ophthalmologists and ophthalmic societies in the Arab and African regions, and update their knowledge by disseminating and sharing information about common problems and diseases in ophthalmology and allied fields in the region.
Each country is represented by the President and the Secretary of the National Ophthalmological Society of that country. A number of international PACO meetings have been organized and supported in Egypt, 1991; Syria, 1993; Morocco, 1995; Amman, Jordan, 1997; [list other PACO meetings); and Lebanon, 2001.
Al Noor Foundation also supported the Joint Meeting of the International Agency for the Prevention of Blindness, the Afro-Arab Society of Ophthalmology and the Ophthalmological Society of Nigeria, Kaduna Nigeria 1996.
Lack of proper training is major constraint to the delivery of effective eye care able to reach the poor. Al Noor provides residency and fellowship training for ophthalmologists and training for administrators, ophthalmic technicians, managers, and nurses. Additionally, ophthalmologists from developing countries are financially supported for attending international meetings. In our training programs we focus on patient centered management to improve overall productivity, financial sustainability, and client satisfaction.
Al Noor supports the El-Maghraby Eye Institute, which provides teaching facilities, including an auditorium for 250, four class rooms with a capacity of 40 each, a skill transfer laboratory, and a library. Training of personnel from African and Middle Eastern countries will be the focus and priority of El-Maghraby Eye Institute. Training will be oriented towards a community ophthalmology-public health approach addressing the magnitude of the problem and concern for the poor, who comprise the greatest number in need.
A short term surgical training course is being designed to upgrade the surgical skills of ophthalmologists. This is being designed in collaboration with Aravind Eye Hospital, Madurai, India and L.V. Prasad Eye Institute, Hyderabad, India. Other training programs will include subspecialty fellowships, continuing medical education, telemedicine, and fully equipped wet labs.
Courses are also being developed that address management and business planning for cost-effective financially self-sustaining eye care programs. Topics will include leadership skills, management structure, staff utilization, purchasing and inventory control, medical records, accounting, financial control, outreach and social marketing, optimization of resources, and development of procedures for efficient operating room procedures in a high volume surgical practice.
Al Noor has established extensive laboratory facilities and collaborations for research into genetically transmitted eye diseases. Collaborative relationships include Johns Hopkins University, Tufts & Louisiana State University.
Al Noor has also recently completed a prevalence study of blindness and major eye diseases in Menofyia, Egypt. The objectives of the study were to determine the prevalence and leading causes of blindness, low vision and trachoma in the adult population (age 50+) and to determine the prevalence of active trachoma among children (2-6 years old). The barriers to utilization of eye care services were also investigated. The survey was conducted in collaboration with the Egyptian Health Ministry, the British Columbia Center for Ocular Epidemiology, the Edna McDonnell Clark Foundation, and Pfizer.
The coverage rate for the target population was 89 per cent for children (age 2-6) and 81 per cent for adults (age 50 +). The survey results indicate that the prevalence for presenting vision in the best eye was 38.4 per cent for low vision and 8.2 per cent for blindness, while the prevalence for vision in the best corrected eye was to 14.9 per cent for low vision and 7.8 per cent for blindness. Active trachoma among children accounted for 36.5 per cent and blinding trachoma accounted for 6.5 per cent among adults.
The three leading causes for blindness were found to be cataract (54.8 per cent), corneal opacities (18.9 per cent) and trachomatous corneal opacities (7.6 per cent). The three leading causes for low vision were refractive errors (49.8 per cent), cataract (24.1 per cent) and trachomatous corneal opacity (10.7 per cent). The surgical coverage rate for those in need of cataract surgery was estimated at 17.6 per cent and 40.7 per cent for those in need for trichiasis surgery. Among those in need of cataract, the three main barriers against seeking cataract surgery were: no need (18.9 per cent), fear of surgery (18.5 per cent) and being too old (18.5 per cent). For those in need for trichiasis surgery the main barriers were ranked as fear of surgery (27.8 per cent), no problem (19.8 per cent) and being too old (13.8 per cent).
Based on the findings of the survey, Al Noor has been able to bring the Ministry of health (MOH), Egypt to a formal recognition that blindness and trachoma are major public health problems in Egypt. At Al Noors suggestion, the MOH has adopted an action plan for the coming years to link with the Vision 2020 Global Initiative.
A partnership has been created that includes the MOH, Al Noor, the Canadian International Development Agency (CIDA), BC Center for Epidemiological & International Ophthalmology, the Clark Foundation and Pfizer. This partnership is conducting a community based program for awareness of trachoma in four Menofiya villages with a high prevalence of active trachoma. The program targets women groups and community leaders. Free eye camps for trachoma are running in four villages to identify cases for medical or surgical intervention. A surgical training program for Menofiya eye surgeons is being conducted to provide training in improved surgical outcomes.
Affordable medical technology
An important aspect of delivering affordable high quality cataract surgery is the production and availability of low cost consumables like intraocular lenses and suture. Al Noor recently supported the development of low cost suture production at Aurolab in India, to make quality ophthalmic suture product that is now being sold at a fraction of the usual price to programs serving the poor. These examples of low cost manufacturing demonstrate that products can be manufactured at comparable quality to those produced in the West. Our challenge is to reduce the cost of necessary products and price them to be affordable to the economies of developing countries where the greatest needs exist.
Donation of equipment
Al Noor regularly donates essential ophthalmic equipment to eye care facilities which otherwise would be able to afford this technology. Recipients have included eye care facilities in Lebanon, Syria, Yemen, Russia, China, Nigeria, Egypt, Sudan, Indonesia Pakistan, Bangladesh Albania and St. Johns Ophthalmological Hospital in Jerusalem.
Al Noor developed and sponsors the publication of the Middle East Journal of Ophthalmology (MEJO), the official ophthalmology journal of the Middle East and Africa.
Al Noor grants several awards which include: Golden Medal; Shield for Prevention of Blindness; International Prevention of Blindness Award, American Academy of Ophthalmology; and the El-Maghraby Award for SOS.
Collaborating Partners For Eye Care Development
To further its objectives, Al Noor collaborates with several leading international organizations dedicated to eye care. These organizations include:
Seva Foundation for the development of low cost ophthalmic suture production at Aurolab, India. Ophthalmic suture remains costly, accounting for a substantial proportion of the cost for surgery in developing countries. It is one of the few remaining ophthalmic products where there is currently no viable inexpensive alternative.
The goal of this project is to produce world class ophthalmic suture and to make it available at a fraction of the present price, thus leading to substantial cost savings for programs serving the poor in developing nations. Al Noor Foundation collaborates with the Seva Foundation, Canadian International Development Agency; Sight Savers, UK and ChristoffelBlindenmission, Germany in support of this development.
Helen Keller International for development of Cataract Centers of Excellence, Morocco & Indonesia. With the support o HRH Prince Abdul Aziz Bin Abdulla, a and the assistance of the Ministry of Health, Morocco, a network of Cataract Centers of Excellence was established through out southern Morocco to provide high quality eye care services in undeserved areas.
Impact Foundation, UK, for establishing regional centers in the Islamic world for the prevention of disabilities.
International Eye Foundation: Al Noor Foundation is collaborating with IEF in the creation of an ophthalmic technician training program designed to introduce the concept of technicians to many countries currently lacking this cadre of health care worker There will be short term, modularized training courses as well as comprehensive one and two year accredited training programs.
World Health Organization: Al Noor contributes to the salary of a WHO ophthalmologists to develop blindness prevention programs for the Eastern
Al Noor Foundation is a supporting member of Vision 2020, a global campaign for the elimination of preventable blindness. This global initiative concentrates on the fight against or treatment of the main functional eye disorders: cataract, trachoma, onchocerciasis and childhood blindness, which is most often caused by vitamin A deficiency.
Among the top priorities are the establishment and development of the necessary infrastructure for the prevention of blindness as well as the training of eye doctors and eye care workers and the use of appropriate technology for treatment and operation of eye diseases. Other members include the World health Organizations and the International Agency for the Prevention of Blindness.
Al Noor receives financial support from individuals, foundations and corporations. Grants are made in support of:
Secondary care eye hospitals:
Mobile services in Africa
Collaborating partners for eye care development
Donation of equipment
The El-Maghraby Eye Institute, Cairo, Egypt