Changes in social structures and cultural patterns: Persistent network of social relationships and blindness.
Blindness as social issue than medical care:
Ophthalmic diseases are wide spread problem in India (Subramanian, K.M., 2008) and can be categorized as cataracts (both immature and mature), glaucoma, and refractive error. The study was carried out by Dandona, et al., (2001) estimated 18.7 millions Indians are blind and majority of them approximately 14.7 millions are living in rural areas. Total blind population estimated across the globe is 37 millions (The Times of India, 2007) and in general, India is a home for largest number of blind people. Dandona, et al., (2001) also estimated half of the blindness due to cataract related issues. Dandona, et al., (2001) further revealed women are 4 times more likely to develop ophthalmic diseases than men. Women also are more susceptible to ophthalmic diseases except 60 years and older than men (Dandona, et al., 2001; Fletcher, A. E., 1999). Human vision also will be compromise by age.
Fletcher (1999) also argued men are twice as likely as women to obtain free eye care and it reflects social inequality and also indicates man domination characters in the society. In addition to that rural Indians are reluctant to obtain eye care even it performed free of charge by many institutions believing that complex medical procedures will further complicate for their blindness. In general it can be explained as fear for surgery (Fletcher, A. E., 1999). Fletcher (1999) also noticed that religious belief and cultural expectations are contributing major influence for this matter. In addition to that 13.9% rural population did not seek medical care or delayed treatment believing blindness is a “God will” (Fletcher, A.E.1999). Indian adults and their family members perceived that, it is not useful to have clear vision at older age. It is common to find elderly Indians are not seeking eye treatment (Fletcher, A.E., 1999; Vatuk, S., 1995).
Ethno-medicine is a cultural, religious belief and spiritual notations surrounding belief of treatments for diseases but not derived from modern medicine (Rubel & Hass, 1990). However ethno-medicine is popular among indigenous people (rural communities) and they would rely on traditional practices to cure diseases. Religious and cultural belief also embedded with ethno-medicine and there are many methods in use to cure eye diseases. However, it is very difficult to find ethno-medicines used to cure blindness. However Basu (1990) was explored how rural communities use ethno-medicine to cure diseases. Basu (1999) also noted that rural villagers are willing to use western medicine as well as ethno-medicine and preference goes to use both at same time.
Srikiran Ophthalmology Centre:
Dr. Chandra Sekhar Sankurathri established Manjari Sankurathri Memorial Foundation (MSMF) in memory of his wife and two children killed in the Air India disaster June 23, 1985. The foundation takes mandate to promote rural education and health care in Kakinada Village, Andra Pradesh. In year 1993 Srikiran Ophthalmology Centre (SOC) established to improve eye health in rural poor. Srikiran Ophthalmology Centre consists with 60 beds and modern out-patients facility and 90% patients receive free eye care, including cataract surgery. Kakinada village is no difference to other rural areas in India. Eye diseases are wide spread among rural populations and approximately 80% of blindness is caused by cataract and that can be cured and easily treated.
Srikiran Ophthalmology eye care Centre is new to rural village Kakinada at the beginning (1989) and it is not clear how rural poor motivated to perform cataract surgery. Ethno-medicine, medical myths, social, cultural, religious, spiritual beliefs are surrounded by the rural communities transformed into use modern western medical treatment. Rural poor deviate or abandoned social, cultural and religious bonds among themselves and powerful transformation took place. Srikiran Ophthalmology centre performed 142,696 surgeries up to June 2009.
(1) How this transformation happened? What factors are motivated rural poor to have cataract surgery to re-store their eye sight? How social structures changed?
Rural men and women who had eye sight become weaker or lost due to cataract. Then their capacity to work or engage with society or family systematically changed (reduced or increased).
(1) How blindness changes power and social structure? (in general Indian society is man dominated one)? What is the mechanism?
Srikiran Ophthalmology Centre performed surgeries for poor rural men and women who had cataract and now their vision is recovering or recovered. In general vision recovery is 70%.
(2) Once rural poor has vision back how social power changed (reduced or increased)? How socio economic recovery took place? Is cataract surgeries done by Srikiran Ophthalmology Centre had real impact on social structures? Will patients back to original power sharing status of the society? What is the mechanism for systematic change?
Open ended and close ended survey questioners (Questioner not designed yet) will be carried out with support of local trained staff. Specific time framed will be established in order to collect data. Sample size and frequency will be established. Same sample will be interviewed to measure changes or new formation. All answers will be voice recorded. Completely randomised model will be applied. In general dependent variables are included: Motivation for treatment, treatment time frame, non-medical forms of treatment, religious and ritual attribution to specific god or goddess, use of spiritual healers or astrologers. Independent variables are included: age, marital status, number of family members or children, current resident, former resident, employment status, occupation of principle income earner, number of years in school, literacy, frequency TV viewing, paper/books or magazines reading. (Subramanian, K.M.,2008). Answers will be coded and analyzed qualitative and quantitative methods and results will be interpreted accordingly. Method and data validation also will be carried out during the data collection and analysis process.
Basu, A. M. (1990). Cultural influences on health care use: Two regional groups in India. Studies in Family Planning, 21, 275–286. Available on World Wide Web http://www.jstor.org [Accessed on February 27, 2010]
Dandona, R., Dandona, L., Rao, G. N. (Eds) (2001). Recent blindness data from India: Policy implications in the context of VISION 2020. International Agency for the Prevention of Blindness News, 2, 6–7
Fletcher, A. E. (1999). Low uptake of eye services in rural India. Arch Ophthalmol,117, 1393–1399.
Rubel, A. J., & Hass, M. R. (1990). Ethno-medicine. In T. M. Johnson & C. F. Sargent
(Eds.), Medical anthropology: A handbook of theory and method. Westport, CT:Greenwood Publishing Group.
Subramanian, K.M. (2008). A Different Type of Medicine: Women's Experiences with Ophthalmic Diseases in Rural and Urban Tamil Nadu, India. Health Care for Women International, (29):400–415
The Times of India (2007). India has largest blind population by Kounteya Sinha,TNN
Wednesday, October 10, 2007 Available on World Wide Web: http://www.freelists.org/post/blindnews/India-has-largest-blind-population[Accessed on February 28, 2010]
Vatuk, S. (1995). The Indian woman in later life: Some social and cultural considerations. In M. Das Gupta, L. C. Chen, & T. N. Krishnan (Eds.), Women's health in India. Bombay: Oxford University Press.