CHAPTER SIX 216 the valleys, reflecting the location of most ophthalmic care in Kath- mandu. The surgical coverage in the terai and mountains is 30 per- cent, and in the hills it is 40 percent. By mother tongue, the Newari community has 68 percent cover- age, followed by a 43 percent coverage rate among Nepali speakers. The poorest coverage is among the Rai, Maithili, Bhojpuri, and Magar language groups. The coverage rate varies sharply by literacy, with 64.8 percent of the literate cataract population having been reached by surgery, compared to 31.7 percent of the illiterate. This indicates again that health education must be clearly targeted to the nonliterate cataract patient. By religion, the coverage rate was 35 percent in Hindus, 39 pel'- cent in Buddhists, and 15 percent in Muslims. The Muslim minority, primarily residing in the terai, has a surgical coverage rate half that of other religious groups.24 The coverage among the four major caste groups does not differ significantly, with a low of 31 percent among the Vaish and a high of 44 percent among Brahmin, suggesting that access to sight- restoring surgery has been relatively equally available without respect to caste. To summarize, the population that has been best served by existing surgical facilities are those who have access to the major centers of eye care in Kathmandu or Sitapur. They tend to live either in the Far West or the Kathmandu Valley, and are literate. The underserved cataract, population tends to be illiterate, more likely to be Muslim than Hindu or Buddhist, and to live in the eastern part of Nepal. Results of Previous Cataract Surgery: Of the 105 aphakics examined in the NBS, 102 (97.3%) were enrolled in a special study and questioned with regard to when and where they were operated, type of facility used, provision of spectacles, etc., and about any postoperative complications they might have had. In addition, each aphakic was examined for signs of postoperative complications such as corneal scars, shallow anterior chambers, too broad an iridectomy, etc. All aphakic eyes were then tested for visual acuity using plus-ten glasses and pinholes. The results of this special study are given in the following section. Sources of Surgery: Two-thirds of the aphakic were operated in Nepal, one-third in India; 51 percent of operations were performed in hospitals, 49 percent in eye camps. The average aphakic traveled 16 hours to reach surgery. Most (93%) were accompanied by a relative. The average patient was operated on five years ago.
