During the July and August 2024 anti-discrimination movement in Bangladesh, around 1000 people suffered a range of ocular trauma during demonstrations across the country. Approximately 700 of these received emergency treatment from the National Institute of Ophthalmology and Hospital (NIOH) and countrywide local eye hospital doctors, with many vitreoretinal surgeries being performed for bullets or fragments lodged inside eyes.
Moorfields Eye Hospital ophthalmic surgeons and retinal specialists, Mahi Muqit and Niaz Islam, were invited to Dhaka by Bangladesh’s interim government to help treat 120 of these patients, saving the sight of 24 of them with complex surgery across four days of intensive support.
The Ophthalmologist sat down with Mr. Mahi Muqit (pictured below) to hear more about this humanitarian effort.
How did your recent work in Dhaka, Bangladesh, helping patients with injured eyes differ from other humanitarian work you have been involved in?
I've actually been working with Helen Keller International (HKI) since 2007; I've been in Southeast Asia with HKI setting up diabetic eye screening programs for them. These projects mainly involve developing new eye screening technology systems, training local mid-level and medical workforces, advocacy, and working alongside Ministries of Health on memorandums of understanding (MOUs). I've been doing this charitable work for over 10 years, including in Bangladesh, so I'm quite familiar with the area.
This effort was a bit different because they wanted me as a vitreoretinal surgeon to come in and treat patients in a different healthcare environment, against a background of the July Revolution in Bangladesh, which began as a student uprising. The government has since been toppled, but back in July and August 2024, there was a lot of hostility. Thousands of people had eye trauma directly from gunshot injuries. The local surgeons across Bangladesh were carrying out emergency surgery to remove bullets and repair traumatized eyes. But when you have ocular trauma, you require silicone oil, because there's a high risk of getting scar tissue afterward. Many of these patients who had been operated on were followed up by local doctors waiting several months for further expert surgical management.
When you've got a severely traumatized eye, it's really about deciding whether it’s in the patient's interests to go back into the eye. I was there with Niaz Islam, who's a medical retina specialist, and we saw about 120 patients on our first day. It was very tiring because we were also fasting in that period, but we managed to get through our cohort, who were in the hospital waiting for the next step in treatment.
Many of these patients, some of whom had lost complete vision, were still waiting for an opinion. Many had some visual potential, so it was about trying to work out how to help the different groups. For the patients who had lost vision, it’s more about psychosocial management. These are young patients, students, varying in age from around 15 to their early 30s. We were trying to counsel the ones that we could not help with surgery. That was one aspect that the local doctors really appreciated because that's what they were struggling with.
Then there were other patients that I felt I could do something for. Many of these had had bullet trauma with associated retinal detachment and macular scar tissue and extensive scarring. We'd had them all scanned with OCT scanners; the local doctors were excellent at prepping them. So, I decided to operate on about 24 patients over two days, which again was complex surgery.
How did you deal with the other pressures of performing surgery in such a highly charged environment?
Last summer you could classify the area as a conflict zone. I think things are much calmer now. I've been over several times as part of my work with Helen Keller International. But there are little incidents and flare-ups. We were mindful about not being involved with the politics of it all. We were there to provide a service for the patients, a humanitarian role.
What kind of training was provided to the local doctors, and what is the potential impact of this on local vitreoretinal care in the long term?
In my current role in Moorfields Eye Hospital, I run a lot of clinical trials – phase I, II, and III – and I thought, let's try and set up some kind of infrastructure where we can follow up with these patients. So we set up the Bangladesh Ocular Trauma (BULAT) study, which has got ethics approval. All the patients that we saw and treated will be followed up by local doctors. That includes the cohort from July.
There are two particular doctors there who are vitreoretinal surgeons and who are key to the care of these patients. They've been liaising with me quite frequently with updates on the patients. Patients that I operated on are now being discharged. My message to the doctors was that you have to let the patients know that they won’t get lost. We've now got a network where we're following the patients up and gathering all the data. We conducted some patient NEI (USA) questionnaires as well; we have almost 100 questionnaires from this validated resource. Later we will go back to those patients and re-assess them to see what the impact has been on their quality of life. I felt that I didn't want to go in commando style, do my work and leave. I wanted a longer-term plan, which is all in place now.
What lessons from this experience would you share with other ophthalmologists interested in global eye health outreach, particularly in war-affected regions?
If you haven't done it before, you have to be very mindful and sensitive about going into these situations, putting patient care at the centre of the mission whilst recognizing the role of training local medical staff and surgeons. There are going to be tragic things that you see that you have to be very diplomatic about.
Quite a bit of pre-planning is needed to reduce the stresses when you are there. We did a lot of logistical pre-planning. We wanted to know how to run the clinics with high volume patients, set up the operating theatres, and arrange the follow-up care plan.
But at the end of the day, you have to have that willingness to serve. At Moorfields Eye Hospital that's embedded in what we do. If you're going to these places, you have to have that burning desire to treat patients in any situation.
