With 90% of the world’s visually impaired living in developing countries, Pakistan is no exception to this on-going global healthcare challenge. Despite massive leaps over the last few decades in targeting this issue, the World Health Organisation (WHO) reports that avoidable blindness is projected to increase over the coming years. The combination of an ageing and growing population has significantly increased the number of people with vision impairment.
There has also been an increase in myopia and diabetic retinopathy. In developing countries weak or poorly integrated eye care services lead to the late detection of conditions which could have been appropriately treated to prevent blindness. There is an enormous financial burden of vision impairment in countries such as Pakistan which despite making many advances in addressing eye conditions cannot progress enough to keep pace with the growing population’s eye care needs.
Princess Alexandra being introduced to Trustees at LRBT by Graham Layton, 1987.
Layton Rahmatulla Benevolent Trust (LRBT) is a non-governmental organisation based in Pakistan which has assisted in halving the incidence of blindness over the last 35 years, but it appears it will have to work harder to keep up with increasing demand. As the largest provider of free eye care in the country, it currently delivers its mission via 19 well equipped eye hospitals and 58 clinics spread out across the country. It is, no doubt, a single remarkable force through which literally millions of the poorest citizens of the country have had their sight restored, significantly improving a patient’s quality of life and their opportunity for economic independence.
LRBT’s largest benefactor is its sister charity the Graham Layton Trust (GLT), GLT is a UK registered charity whose heritage dates back to the early 1980s, when retired Royal Engineer and businessman, Gordon Graham Layton OBE, decided to begin a project that would capture the hearts and minds of those living hundreds of miles away in the UK. The realisation that many eye diseases are curable, yet those unable to afford treatment routinely go blind, led Graham to begin an eye care initiative in which anyone could receive free high-quality ophthalmic care.
Ceremonial ground-breaking of central office, 1990.
LRBT Lahore Hospital.
LRBT Karachi Hospital.
Endorsed from the onset by SightSavers International, both clinically and medically, LRBT surpasses all WHO standards of care and routinely achieves excellent reviews in its audits. The central ethos of the organisation that ‘charity should not mean second rate care’ is evident through and through. Its largest teaching hospitals in Lahore and Karachi boast cutting edge technology on par with that of many UK teaching hospitals. Its doctors are also highly trained and dedicated ophthalmologists performing a multitude of eye surgeries from cataract to retinal detachment. An on-site completely free pharmacy exists for after care, as medication can be costly and difficult to access.
LRBT Karachi Hospital: Paediatric clinic.
For many of the 10,000 patients that visit the LRBT network on a daily basis, a staggering 1,000 surgeries are performed daily. Most recently, in Karachi, LRBT successfully treated its first patient for keratoconus by corneal cross linkage completely free of charge. Here in the UK, such a procedure could cost up to £1,000 or more. In the future, LRBT hopes to continue building its level of expertise by adopting innovative approaches to treatment.
Despite LRBT’s widespread reach (LRBT has about 75% coverage of the country), many will have travelled far and saved for months to afford the fare so it is vital that everyone is assessed and treated the same day, wherever possible. For those unable to travel, LRBT goes to them: by teaming together an ophthalmologist, technician and mobile clinic, even the remotest areas of the country are reached through eye screening camps. This allows for a whole village to have their eyes tested over a day or two, often sponsored by UK volunteers. Dr Fawad Rizvi, Chief Consultant Ophthalmologist (LRBT Hospital, Karachi), has been dedicated to this cause for over fifteen years. He describes the growth of LRBT from a single ‘caravan or coach’ operating theatre set up in 1984 to the current extensive eye care service provision for the indigent population of Pakistan. Dr Rizvi reiterates the LRBT ethos of free eye care: ‘No man, no woman and no child should go blind simply because they cannot afford it.’
Alongside its clinical work, LRBT runs the largest Postgraduate Ophthalmic Fellowship training programme in Pakistan, which is accredited by the College of Physicians and Surgeons. It also runs a School of Paramedicine, which trains optometrists, ophthalmic technicians and operating theatre staff. To ensure all round best practice, GLT is currently developing an observership programme whereby Pakistani LRBT ophthalmologists will be attached to consultant ophthalmologists within UK teaching hospitals so they may further develop their knowledge and skills.
Although 70% of funds are raised in Pakistan, LRBT is still heavily reliant on GLT to provide funding for the entire annual supply of intraocular lenses for the LRBT network, plus funding for additional equipment and resources on a needs basis. This is all spearheaded by its team in London which include its Patron, Lord Michael Dobbs, whose predecessors included Viscount John Slim and Lord Bernard Weatherill.
Many UK ophthalmologists have over the years visited Pakistan and supported the LRBT Hospitals. Professor Christopher Lloyd, Consultant Paediatric Ophthalmologist at Great Ormond Street Hospital with a research interest in inherited eye disorders and childhood cataract, has supported GLT and assisted with the purchase of a Retcam so that the LRBT Hospitals may expand their screening program for retinopathy of prematurity. Consultant Vitreoretinal Surgeon, Rahila Zakir at The Western Eye Hospital also supports the work of GLT. GLT’s Board of Trustees, which include actor Art Malik (whose father was an ophthalmologist), continue to raise the awareness of this charity so that Graham Layton’s legacy may support the visually impaired population of Pakistan. To that effect, a number of fundraising galas and events take place throughout the year.
GLT is extremely proud of its association with LRBT and the work the two organisations carry out in helping some of the poorest people in the world to see, better enabling them to lead more fulfilled and independent lives. The organisation is proud of its links with UK ophthalmologists and welcomes more colleagues to join its own Board of Ophthalmologists in an advisory role. As well as the undoubted support and benefit this gives to ophthalmologists working at the LRBT Hospitals in Pakistan, this can also be a wonderfully rewarding opportunity for those based in the UK. Through this Board of Ophthalmic Surgeons and other professional contacts, GLT hopes to increase its ability to provide observerships both for experienced LRBT eye surgeons and also those who are still in training.
Graham Layton.
Graham Layton’s credibility as an extremely successful businessman in Pakistan (he founded a construction company that built most of the buildings in Karachi) and his undoubted passion, meant that he was a trusted ‘do-er’. That is, his determination was a driving force in what today can easily be regarded as a phenomenal success. However, there is still much left to be achieved. In 2020, a significant year for vision, it seems poignant to remember Graham’s extraordinary efforts.
So far 43 million patients have been treated and their sight transformed.
For further information, visit www.glt.org.uk.
For enquires on the GLT ophthalmologist exchange programme, sponsoring an eye camp, or general information, please get in touch at salina.zaheen@glt.org.uk
For further information on visiting LRBT hospitals or if you are able to offer an observership for visiting LRBT ophthalmologists, please contact: yasmin.riaz@glt.org.uk
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