Adorned with three large Murmas (nose rings), a crooked-tooth smile, and spectacles, a woman from the Dongria tribe deftly knits an intricately designed shawl. This scene is a familiar one in Khambesi Village, nestled in the Muniguda district of Odisha, home to the Dongria tribe. The socio-economic status of the Dongria people is often reflected in the quantity and quality of their ornaments. Among their eclectic adornments, spectacles stand out as a curious addition. However, integrating spectacles into this community was no small feat. It required persistent efforts, including patient counselling and vision screenings, to overcome initial resistance.

Reveling in Kingly Abundance
Before delving into the aspects of eye health for this tribal population, let us first get a better understanding of the Dongria community. The Dongria tribe of Odisha's Niyamgiri hills hold a spiritual bond with their land, viewing it as a divine gift from their deity, Niyam Raja. The name "Dongria" originates from the term dongar, referring to agricultural land cultivated on hill slopes of the forests. The Dongria community and other tribal populations are well-known for their expertise in using medicinal herbs to treat ailments such as arthritis and malaria. Of Odisha's 62 Scheduled Tribes, 13 are classified as Particularly Vulnerable Tribal Groups (PVTGs), with the Dongria being the largest.

The Roadblocks
While they maintain a self-sufficient, nature-dependent lifestyle, their isolation, limited healthcare access, and lack of awareness expose them to significant health vulnerabilities. This challenge is prevalent among India's tribal populations, who constitute approximately 8.6% of the national populace, equating to over 104 million individuals. These communities often experience a "quadruple burden of disease," encompassing communicable and non-communicable diseases, malnutrition, and mental health issues.

From an eye health perspective, the Dongria community experiences high rate of visual impairment and malnutrition. Vision issues deeply affect the Dongria community, impacting their livelihood, safety, and well-being. As they rely on agriculture and forest-based activities, impaired vision hinders their work, increasing the risk of falls, snake bites, and accidents in hilly terrains. Social stigma and dependence on others can lower self-esteem and reduce independence. Limited awareness and healthcare access often leave conditions untreated, worsening their challenges over time.

Eye to Eye
To address the eye health needs of the Dongria tribe, Mission for Vision, Wen Giving Foundation, L V Prasad Eye Institute and tribal ministries of the Government of Odisha and India joined hands to facilitate community eye health interventions for this group. Language posed an initial barrier, and with the intervention taking place during the second wave of COVID-19 pandemic, extra precautions were taken. Staff were provided with sufficient Personal Protective Equipment (PPE) and the team encouraged vaccinations among vulnerable tribal members. Before venturing into the deeper tribal pockets, the eye health staff underwent comprehensive training, followed by a trial visit to familiarise themselves with the community and potential challenges.

Initially, the team faced resistance and limited awareness about eye care. The community was skeptical of modern treatments or surgeries and they held firm on continuing with the age-old practices of tribal medicine. However, the involvement of youth and community leaders played a crucial role in building trust. One such individual is Puliki Wadaka, a youth who seamlessly blends modern and tribal lifestyles. As a Community Health Worker for this project, Puliki played a pivotal role in persuading the elders to participate and conducted several meetings to gain their trust and co-operation for this intervention to go smoothly. She also walked the extra mile by accompanying patients to the base hospital for surgeries when needed. Fluent in Kui, the local tribal language of Odisha, and deeply connected to her community, Puliki effectively conveyed the importance of eye health and influenced members to undergo eye examinations.

Reflecting on her journey, Puliki shared, “Initially, when patients went to the hospital without me, I heard that many refused surgeries, and some even fled from the operating table. Realising the need for support, I began accompanying them to bridge communication gaps and alleviate their fears about visiting an unfamiliar place. Today, those who once hesitated even to get an eye examination now wear spectacles confidently. Many express their gratitude for the quality surgeries that have restored their vision, enabling them to see clearly and live freely.”

Puliki in White Salwar Kameez

Seeing Clearly for a Better Tomorrow
This collective effort successfully conducted eye screening for 89% of the Dongria indigenous community between July 2021 and January 2022. Alongside the screenings, the team educated the community on essential well-being strategies, such as handwashing and the use of mosquito nets. They also measured basic health parameters, providing valuable insights into the general health and lifestyle of the Dongria tribe.

The Tribal Odisha Eye Disease Study (TOES) findings revealed that 31% of the community had visual impairment (VI), primarily due to cataracts and uncorrected refractive errors. Additionally, 17% of children were malnourished and stunted for their age, 9.3% had vitamin A deficiency disorders, and 4% suffered from hypertension. During this period, the initiative dispensed 1,484 spectacles and performed 134 cataract surgeries, significantly improving the community’s quality of life.

Interventions like these may appear simple, yet they play a transformative role in delivering essential services to the communities that need them most. Breaking through the initial resistance of a community and earning their trust to accept eye health services is no small feat. This success hinges on patience, thorough counselling, and the active involvement of youth from within the community itself.

At the core of such programmes lies collaboration. Their success depends on the seamless integration of efforts from all stakeholders - government bodies, funding institutions, eye hospitals, and the community. By working together with the shared mission of restoring sight and transforming lives, these programmes not only improve vision but also empower individuals, families, and entire communities.

About the Author:

Shrikant Ayyangar is the Lead for Communications at Mission for Vision, where he spearheads the organisation’s communications efforts and plays a key role in communication strategy, website management, social media outreach, media relations, content curation and branding activities.