May 2011 Swaziland
Dr Conrad Schmoll ( Specialty Registrar in Ophthalmology – South East of Scotland) - Good Shepherd Hospital, Siteki, Swaziland.
Swaziland has a population of around one million with an HIV infection rate of around 25%. There is 1% prevalence of blindness, half of which is due to cataract blindness. Because of the HIV/AIDS epidemic, the population demographic is skewed towards a population of elderly and children, with the 20-40 age group underrepresented. This has resulted in a large number of orphans being cared for by elderly extended family members...as many as 60% of the cataract surgery recipients are raising children not their own. The reciprocal is also true that when an elderly person otherwise dependant on the care of younger members of the family has his/her sight restored by cataract surgery, this frees the more economically active relatives to provide income for the extended family. Thus the positive impact of cataract surgery extends well beyond the patients themselves and into the welfare of the wider community.
The greatest privilege that a doctor has is to be able to offer skills and expertise to people in need, whether that be in the first or developing world. Probably the biggest highlight for me was in meeting Swazi people, playing a part in their treatment and experiencing their generosity of spirit – ‘even the poor man has a gift to give’. Going on this trip was also an excellent learning opportunity and there was good exposure in the clinics to a wide range of advanced pathology otherwise not commonly seen in the UK. Examples include HIV related eye disease including CMV retinitis, ocular cysticercosis, toxoplasma retinitis, Eale’s disease, dense cataracts and advanced glaucoma.There were also opportunities to perform a large variety of other ophthalmological procedures. I would like to gratefully acknowledge the Fiona Dolan Fund for making this trip possible for me – it was a truly inspiring experience that brings both fresh perspective to my UK practice and sows the seeds for further involvement in eyecare in developing countries.
January 2011 Ethiopia
Dr John Murdoch, Dr Harold Bennet, Dr Isabella Mitrut, Dr Simon Hewitt, Dr Alan Cox. Nurses: Ergate Ayana, Veronica Stewart, Fiona Freeland, Diane Harrison, Moira McLaughlin and Steven Hay,(privately funded)
Report from Steven:
Dembi Dollo is a small town with a large hinterland near the Sudan border. The existing general hospital is 90 years old but a few new buildings have recently been built and we have been given one of these to set up our clinic. The general area is poor and most people live at subsistence level. There is huge need for eye surgery as there is a high level of early onset cataract.
All the patients had been pre-screened for cataracts by a local ophthalmic nurse who works for a catholic charity elsewhere in Dembi Dollo. His operation, which has 2 nurses and very occasional visits by a foreign ophthalmologist, is the only ophthalmic service of any sort in Dembi Dollo. They charge for treatment and so the poorest rung of society cannot access their care. We do not charge and therefore can offer treatment to these people. Patients from different regions came on different days, some from 200k away. Some two to three hundred patients were successfully operated on. The doctors felt it was the best place they had been to in Ethiopia in terms of the local people and their willingness to learn and help (eg local nurses assisted many of the operations).
The hospital is state owned and is free but has no eye clinic. I spent some time with the very pleasant and intelligent hospital manager, Birhanu. He is very keen to have an eye clinic and to that end he has sent two of his best nurses up to Addis Abiba to be trained as ophthalmic nurses. These nurses will be able to do screening, diagnosis and minor operations and this will be a big step forward for the local community. To do this, however, they need to be properly equipped and this is where we come in. We will undertake to send a list of supplies when our next trip goes out in October of this year. The supplies range from an operating microscope and slit lamp, to lenses and eye drapes. We plan a trip out in October (not me this time!) when the equipment will be installed and the clinic named and dedicated to Fiona.
Thanks to everyone who has made this possible.
----See photos from the trip by clicking on Flickr button----
October 2010 Nigeria
Dr. Rosie Brennan (Consultant Ophthalmologist, Western Health and Social Care Trust, Northern Ireland) - ECWA Eye hospital, Kano, Nigeria.
ECWA Eye hospital receives on average 3 new cases children with retinoblastoma a week. Currently they are giving many cycles of chemotherapy and the patient’s family struggle to find the time and money to complete the course. Some children also get radiotherapy which is not a treatment used in developed countries as it confers a high chance of developing secondary tumours.
I was struck by the numbers of children with retinoblastoma whom they treat. This is an ocular tumour that in developed countries is caught early and treated so effectively that the mortality rate is about 3%. Unfortunately in Nigeria the patients tend to present very late, which results in a mortality rate of about 90%. The mortality rates will drop precipitately if children are seen earlier when the tumour is confined within the eye and the eye is speedily removed. I anticipate that we will be able to draw up a protocol of treatment which will have fewer chemotherapy cycles and no radiotherapy. Thank you again for your support of our project aiming to improve outcomes for children in Kano, Nigeria with sight problems. Thanks to the trustees of the Fiona Dolan Fund for supporting my attendance at the Kenya Retinoblastoma strategy group meeting in September.
September 2010
Dr Shyamanga Boorah (Specialist Registrar in Ophthalmology, Edinburgh, (SE Scotland registrar rotation) - Nkhoma hospital, Malawi
The Nkhoma Eye Department is primarily responsible for providing eye care to the neighbouring Lakeshore District, with a population of about 2 million. The estimated prevalence of blindness is 1%, of which 50% is due to Cataract. Glaucoma and Corneal Scarring from trachoma are the other leading causes of blindness.
My main aims during this trip were to help strengthen the links between Scotland and Malawi and to learn the sutureless extracapsular cataract extraction technique. Medically, I saw cases routinely that would only rarely be glimpsed in NHS practice. I learnt about the interaction between villagers and traditional healers. I saw approximately 6 post ops, 12 review patients and 12 new patients every morning with the help of the patient assistants translating. I would like to thank the Fiona Dolan fund for sponsoring the visit. It has allowed me an experience that I would not normally be able to have self funded easily.
May 2010 Tanzania
Dr Taha Y. Ahmed (Specialist Registrar in Ophthalmology, West of Scotland rotation)- Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) Hospital, Eye department, Dar Al Salam, Tanzania.
It was a privilege to receive a grant from the Fiona Dolan Fund towards my trip to CCBRT in Dar Al Salam. My day started with post operative ward round followed by a prompt start in theatre till 4 pm, working alongside the local surgical team, in particular Dr Richard Bowman, who has dedicated the last 8 years to refining the eye unit to provide a high volume service for the local community in Dar. Fifty cases or so are performed on a daily basis through the year. Some of the services provided: paediatrics, vitreoretinal, cornea and cataracts. The pathology was diverse and advanced and most patients came from deprived backgrounds. One of many highlights of my visit was restoring sight to a blind patient with bilateral advanced cataracts; I had the opportunity to operate on both eyes within the same week, and many more similar examples. I performed 38 cases during my 2-week visit, the majority of which were cataracts, the commonest cause of blindness in Africa. Words cannot express how rewarding the visit was.
----See photos from the trip by clicking on Flickr button----
January 2010 Ethiopia
Dr Heather Russell (Specialist Registrar in Ophthalmology, West of Scotland rotation)- Cataract Camp: Arba Minch, Ethiopia
Ethiopia is a landlocked country in East Africa with an estimated population of over 64.9 million people, of whom 80% live in rural areas. Ethiopia remains one of the poorest and least developed countries in the world, with 8% of the population being blind, 46% of these being blind from cataract The vast majority of the country’s ophthalmologists are based in the capital, Addis Ababa, leaving the rest of the country with a dearth of ophthalmic care.
A grant from the Fiona Dolan Fund enabled me to take part in this trip, which almost ended before it started due to increased customs regulations almost preventing our baggage from entering the country. However after patient negotiations we finally made it to Arba Minch with only half a day operating time lost. Over 1200 people attended the unit with eye problems. Every morning we were met with a waiting room full of people who had travelled for miles for their surgery – some as far as 600km. The work was long and hot, but extremely rewarding. Many patients ‘praised God’ and us for giving them their sight back when we saw them at their post-operative review the following day, with several letting out cries of sheer joy when their dressings were removed.The trip was an amazing experience, both personally and surgically, and I am privileged to have been able to use my skills in such a humanitarian way.----See photos from the trip by clicking on Flickr button----
January 2009 Ethiopia
Dr Suzannah Drummond (Specialist Registrar in Ophthalmology, West of Scotland rotation) - Cataract Camp: Ethiopia
The hospital’s “Eye Clinic” was a series of basic rooms, with no running water. We set up an operating theatre with the four operating microscopes taken with us and proceeded to treat the patients who had previously been pre assessed by the main ophthalmic nurse. Altogether, we performed 298 operations over the 7 days, normally starting at 8 in the morning and finishing at 6 at night with a token 15 minutes for lunch. The operations were challenging both due to the advanced disease in the patients and the poor resources (often the electricity would fail during an operation leaving you to the to perform the rest of the microsurgery in torch light!). The trip was utterly exhausting but extremely enjoyable and rewarding. I would do it again in an instant. It was particularly satisfying to see patients who had initially had to be led in by family members, be able to walk out the following day unassisted.
