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A new vision

The Oyooni Mobile Eye Clinic aims to deliver specialised eyecare to diabetes and glaucoma patients in Palestine. Dr Ali Dabbagh speaks to Alex Westcott about his treatment initiative that requires a wealth of compassion... and a rucksack

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Friday

We live in a world where we expect life to be in complete consonance with our needs and wants. And why not? We have struggled enough, devised enough and worked hard enough all these evolutionary years to want this privilege. While many modern privileges that come to your doorstep are arguably dispensables, there are others which are comfortingly indispensable. One of the most philanthropic aspects of medicine, apart from its raison de etre, is that it does pay attention to the condition of those who cannot come to it and so goes to them. In today's world shaped by technology and powered by an increasing awareness of humanitarian deeds, reaching out to people in need is a choice that needs to be made. It is as simple as that. Because everything else to help you make that choice is extremely accessible.

Medical healthcare providers are turning increasingly to the option of mobile medical clinics to expand their community outreach in rural areas. Providers are attracted to the flexibility and efficiency of the mobile clinic for delivering vital healthcare services, especially for underserved populations. The advancement of telemedicine technology has simultaneously allowed for the gap between the mobile clinic and a fixed-site clinic to be bridged.

In a country like Palestine, whose medical infrastructure has been drastically compromised by the ongoing occupation, a mobile clinic seemed to be an initiative with numerous possibilities, especially when considering that the task at hand is treating a population that has only about 12 specialised ophthalmologists. There is not one diabetic ophthalmologist among these, despite the fact that the population of the West Bank numbers over three million people, 14 per cent of whom suffer from diabetes.

It was with this in mind that Dr Ali Dabbagh a Dubai-based medical ophthalmologist set up the Oyooni Mobile Eye Clinic in July last year. Meeting the doctor at his clinic in Dubai Health Care City makes you see that he is a man who is all about heart. You also see that Oyooni is a project that is not initiated as a result of guilt-inspired morality in fact it's a passion that comes as naturally to the doctor as breathing. Dr Dabbagh is a GCC national of Palestinian origin and, albeit a latecomer to Palestine, has an intense connection with his country. It's a relationship that is re-enforced with every mission he undertakes.

With over eight years experience in the management of glaucoma and diabetes and a Master's degree in Medical Law, Dr Dabbagh has given his project a focused identity. The project is growing from strength to strength with the support of NGOs, his family, friends and his colleagues at DHCC in offering treatment to hundreds of Palestinians who otherwise would have had to struggle to receive any kind of treatment.

Oyooni is derived from the Arabic term for 'my eyes' (also used as a term of endearment for loved ones). It is a non-profit organisation driven to raise funds to purchase new equipment for the treatment of patients in Palestine. Oyooni works in collaboration with Palestine Red Crescent Society, St John's Eye Hospital, Medical Aid for Palestinians and the United Nations Relief and Works Agency. Dr Dabbagh is also working with the Palestinian Children's Relief Fund with the aim of bringing children from conflict areas for treatment here in Dubai.

"It's a known fact and a commonly used phrase that 'the eyes are the gateway to the soul,' and we underestimate the truth that holds," says Dr Dabbagh. The same can be said for medicine. The doctor explains that an ophthalmologist can diagnose 80 per cent of ailments by examining the eyes.

The percentage of the population suffering from diabetes in the Middle East is, he says, particularly horrifying, with the UAE currently having among the highest rates in the world. "It reflects badly on our society in terms of lifestyle, health and affluence," he says raising his eyebrows. "It's an extremely horrible disease horrible in the way that all diseases are horrible. When something like cancer hits you, it makes you sit up and take notice. Often as not, people with diabetes ignore or are ignorant of the symptoms and they opt for a diagnosis only when it is too late. There are a number of consequences and one of the most dangerous results of this delay is the onset of a loss of vision. Which is why it is my duty to encourage early and regular screening. The best cure is prevention," he says.

"The mobility of Oyooni makes it easy to get to patients who are finding medical facilities hard to reach. There is a general lack of knowledge about the risks of not treating diabetes and its symptoms. Patients tend to neglect their condition. This can be avoided if the proper information and preventative treatment is made available to people. This information needs to be well communicated for it to be effective," he says.

The doctor talks of how his project works: "[In this project] you're using the same principles in dealing with the disease but in two completely contrasting societies. The idea of the mobile clinic is based on the principle of offering treatment in areas that do not have ready access to proper medical care."

In the circumstances and situation that Palestine presents, endeavours such as Oyooni are very much needed. There's a high prevalence of diabetes and glaucoma in the area because of the lifestyle its people are reduced to living. The occupation and numerous military checkpoints has brought with it poor nutrition and limited access to healthcare. The mobile clinic's objective is to screen as many patients potentially diabetic and actual diabetics as possible, and to diagnose and treat accordingly. "I'm not a specialist in other diseases. I'm an ophthalmic diabetic physician who diagnoses this condition by examining the eye. By doing this I can establish who needs treatment, provide the treatment [laser and injections, where appropriate] and ensure the patients are referred to whoever can help them further according to their condition."

The concept of a mobile clinic is not new. Mobile clinics come in different shapes and sizes and offer varying specialisations. Today there are mobile medical services with surgical facilities. Dr Dabbagh says initially he thought he would achieve his goal of being a mobile campaigner by going around on a motorbike with a sidecar. "Ideally, of course, a double-decker London bus with lots of space upstairs and downstairs would do," he laughs.

Dr Dabbagh tries to go to Palestine every three to four months. Despite financial pressures, he travels whenever the need arises. "I'm a hands-on coordinator," he says. "It's a process of cooperation of healthy symbiosis. Our aim is to get as many people screened as possible. Truthfully, getting from point A to B is a luxury we often take for granted. I welcome any volunteers to join the cause. Good intention and a good heart is all we look for."

How does Dr Dabbagh transport his equipment? In a rucksack literally, in a big, standard rucksack! "All the equipment I need [for the project] is smaller and portable," he explains. "We contact the ministry or the health provider in the area to notify them that our services are available to anyone who wants to have their eyes checked. Check ups and treatments are voluntary; I am merely there offering a service to those who seek it."

But there's also another element to the Oyooni initiative education. Dr Dabbagh works in tandem with community workers, paramedics, local nurses and doctors to pass on his skills. "A significant part of the objective is training. We conduct courses for those we believe can be the foundation of this kind of a project nurses and community workers. I think they are often underestimated and remain forgotten. But they're the crucial link. I think it's vital to empower them [with knowledge]."

Because Oyooni's existence is dependent on funding, the ultimate goal this year is to set up the telemedicine system which will allow local doctors to conduct screenings on their own without Dr Dabbagh having to physically be present on location. The local doctors will then e-mail their findings to Dr Dabbagh in Dubai, who will advise from here in consultation with other specialists. To reach this milestone, Dr Dabbagh is collaborating with Birzeit University's IT department to develop software that will facilitate ongoing screening and diagnosis, even when volunteer doctors are not able to be present. This way, their time is maximised on treatment when they are visiting.

The fact of the matter is that whether you're in a remote area or in a modern city, the same principles apply. As Dr Dabbagh says, "In an Utopian scenario, the best treatment is prevention. Each individual, as far as possible, needs to be responsible for leading a proper lifestyle."

But in the real world, it's not always that simple. Dr Dabbagh has met patients in Palestine who have no more than the equivalent of Dh100 a month on which to survive, and children too often fall within this desperate income. He realises that no matter how much he may preach on the importance of a healthy diet, it is unrealistic for many people to follow that advice.

At the end of the day, every case has to be judged on its own merit. But to make a difference, you need a diagnosis and to get a diagnosis, you need to be screened. To be screened, facilities need to be accessible. This is where projects like Oyooni make all the difference.

"We need to do something I need to do something," says Dr Dabbagh. "I need to say that I've done my best. And being stubborn, I most certainly will never give up." For more information visit www.oyooni.org.

- Alex Westcott is Sub Editor/Writer, Friday

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