Botswana June/July 2017
Ian McCormick, Optomotrist
I applied to Fiona’s Eye Fund for a grant to help fund the cost of a research project undertaken as part of the MSc in Public Health for Eye Care at the London School of Hygiene and Tropical Medicine. The project was ‘A Review of Spectacle Compliance and its Determinants in a School Vision Screening pilot in Botswana’ and the fieldwork took place in June and July 2017. My project entailed 4 weeks of unannounced school visits to check compliance with spectacle wear and investigate factors associated with compliance and children’s reasons for wearing and not wearing their spectacles. Compliance is a key component to any screening programme and some previous studies have shown it to be low – an important barrier to reducing uncorrected refractive errors. I followed up 193 children across 19 schools, and data on gender, age, school level, visual acuity and refractive error were analysed to investigate factors predictive of compliance. Children whose vision improved by 2 or more lines with spectacles were more likely to be wearing them in class. Peek Botswana aim to roll out school vision screening to other regions next year and achieve national coverage by 2020. This will provide all schoolchildren with access to eye care in a country where human resource shortages mean most would otherwise go without. I hope my project will contribute to making the scale-up more effective, efficient and sustainable and I would like to thank Steven, and everyone else involved with Fiona’s Eye Fund, for helping me to contribute to this innovative child eye health programme

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Dr Aaron Jamison
 In 2005 the Malawian Ministry of Health identified the absence of any dedicated paediatric ophthalmology service and with the assistance of Vision 2020 forged a link between the Lions Sight First Eye Hospital (LSFEH, Blantyre, Malawi) and the Royal Hospital for Sick Children (Yorkhill, Glasgow, Scotland), .... Several years later, the service was in place but appeared to receive limited referrals, especially from more distant districts within Malawi, and so attention turned to the Ophthalmic Clinical Officers (OCO) – Malawi’s front-line ophthalmic healthworkers, responsible for the diagnosis and referral of ophthalmic conditions across the country. ….. In 2016, with the link drawing to a close, efforts have focused on smoothly transitioning to an all-Malawian delivered paediatric ophthalmology course and this handover process formed the basis of this trip. In September 2016 I travelled with Dr Tim Lavy (consultant paediatric ophthalmologist), Neil Drain (Optometrist, Specsavers Kirkintilloch), Sarah Cornelius and Janice Waterson Wilson (both Orthoptists at the Royal Hospital for Children, Glasgow) to the LSFEH to help deliver the 6th annual paediatric ophthalmology training course.My main objective during the trip was to collect data that might reflect the development of the paediatric ophthalmology service over the years of the Glasgow-Blantyre link and our chosen field of investigation was paediatric cataract surgery. Little has been published on this subject in Malawi, likely due to the lack of infrastructure required to enable effective health records....  a single filing cabinet containing the case notes of children who had undergone cataract surgery from 2011 to 2016. The collection of records was unordered and incomplete so I took a sample of 25 patients from each of the available years and spent long days gleaning any useful data relating to the surgical procedures performed and their outcomes. We hope to publish this data so that we can offer outsiders a window into the working life of a paediatric ophthalmology service providing cataract surgery in Africa.  I, the Glasgow-Blantyre Vision 2020 Link team, and the Lions Sight First Eye Hospital would like to thank Fiona’s Eye Fund for their support, without which this work would not have been possible.

 

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Baladi Foundation, Aswan city, Egypt January 2016

Dr Mahmoud Radwan - Specialty Registrar in Ophthalmology – Dunfermline
At a very short notice I applied for a grant from Fiona’s Eye Fund in January 2016 to support my trip to Baladi foundation eye clinic, a non governmental organisation based in Aswan, Egypt. Aswan is located at the borders between Egypt and Sudan and is considered one of the remote districts in Egypt where a large population suffer from low health and socioeconomic status. I had the privilege to join Dr Tarek Shaarawy who is one of the leaders in glaucoma not only in Europe but also all over the world and also to meet the local team in Aswan.The aim of this trip was to help the local community in Aswan in management of glaucoma in both adults and kids as we know that glaucoma is more aggressive in Africa than in Europe. The visit started by screening patients for congenital and adult glaucoma. According to the severity of the glaucoma and the socioeconomic circumstances patients were divided into a medical and a surgical group. The medical group of patients were given the required and sufficient medications. The surgical group were transferred to a surgical centre where they underwent the appropriate surgical procedure. I had the opportunity to teach and supervise the local medical team how to perform some procedures (Cyclodiod Laser Photo-co-agulation, Gonioscopy, and Trabeculectmoy). We provided some of the consumables and the valves needed during the surgeries. At the end of the day we organized a glaucoma workshop to share experience with the local medical team and set plans to manage glaucoma properly in light of the bad socioeconomic status of the community. Personally, I had the opportunity to perform a large variety of other ophthalmological procedures and gain experience from the team. Many thanks to the trustees of the Fiona Dolan Fund for supporting my attendance. 

 

Patandi College, Arusha and Moshi, Northern Tanzania November 2014

Laura Todd - Orthoptic Support Worker
I was part of the Rotary/NHS Fife team which travelled to Patandi College in Arusha, N Tanzania, to teach tutors visual screening, albinism awareness and low vision rehabilitation. The trip consisted of a mixture of teaching and practical vision assessments, so that teachers would be better able to spot visual problems and understand some of the common strategies to minimise the effects of visual impairment.
Over the course of the visit we tested over 125 children with the majority affected by albinism. Most of the children had poor vision, photophobia and/or strabismus, nystagmus and cataracts. After assessment each child received specialist filter glasses to reduce glare and were also given a low vision device of this was helpful. The focus of the trip was to ensure that any child in the future who required specialist intervention would be more able to access the help that was needed. We were able to do this by writing a training manual for the tutors to use in their teaching curriculum and forging links with a local hospital who were willing to offer help to any puipils whom the tutors identified as having a potential vision issue. We were also able to carry a significant stock of low visual aids and provide vision testing equipment for tutors to use in the future. Dr Jennifer Skillen, head orthoptist at Fife NHS applied for funding to support my place with the project group and we would like to express our gratitude to Fiona's Eye Fund for enabling this to happen.

 

The Lions Sight First Eye Unit at Queen Elizabeth County Hospital, Malawi September 2014
Dr Laura Butler
In September 2014 I had the privilege of travelling to Blantyre in Malawi to carry out a validation study of a newly developed digital tablet based vernier acuity test designed for children. It is well known that the testing of infant acuity is extremely important in identifying children who need intervention to correct their vision at an early stage in order to avoid the devastating consequences of amblyopia and potential blindness in the affected eye. Current card-based “gold standards” to measure this have a number of problems including expense, wear and tear problems, portability issues and child engagement with testing. For resource poor countries, the availability of a cheaper, more portable and more interactive test could be of immense value, and our aim was to show that the new digital based test could be used in place of the more expensive and cumbersome card based tests that are currently in use.
Armed with an iPad and a set of Keeler Acuity Cards, and with the help of a Malawian colleague Dr Esther Misanjo, I visited the Lions Sight First Eye Unit at Queen Elizabeth Comunity Hospital over a period of 9 days. We tested the visual acuity of over 50 children aged between 6 months and 4 years using both of these methods. Despite the fact that most 1-4 year olds in Malawi have never seen an iPad before, they responded enthusiastically to the new test (particularly enjoying the “yippee” when they got it correct!) and engaged well with it. The raw data obtained is still in the process of being analysed with a formal report to follow shortly. Below are some pictures of my trip and of the testing.Carrying out this study was a hugely enjoyable experience. I was able to interact with many different children and their families and gain some insight into the different culture and lifestyle in Malawi and the approaches and attitudes to healthcare. I was able to leave the unit with the Keeler Acuity Cards that I took out for the study which they will be able to use in their clinics in future. It was also a wonderful opportunity to build up international relationships with ophthalmology colleagues in Malawi which will hopefully be a good basis for future collaborations.

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Himalayan Cataract Surgery Project, December 2013
Dr V. Swetha E. Jeganathan
I had a special reason for choosing Nepal- a land blessed with stunning panoramic views of the Himalayan range which forms a majestic backdrop. Having been brought up in Australia, I had been tremendously inspired by Fred Hollows and wanted to emulate his footsteps for as long as I can remember. This dream became a reality through Fiona Dolan’s generous donation of funds. During my stint in Hetauda, I had the opportunity to examine more than 1000 patients and successfully perform 17 small incision cataract surgeries on the dreaded black cataracts, where most individuals suffered from dense cataracts with concurrent infections, corneal pathology and malnutrition. I was pleasantly surprised by the amazing post-operative Day 1 results, given the complexity of these cases and my relative inexperience of this surgical technique. The Nepali hospital team watched with attention and pride over the line of patients that I operated on. I felt a flush of immense joyful elation when the post-operative eye patches were peeled back to deliver a newly opened world to these patients.  There is indeed something really humbling about performing cataract surgery in rural Nepal. You realise that healing is a sacred privilege. Patients often originate from remote regions to attend the high-volume clinics or outreach screening camps that I had the honour of actively participating in, despite my handicap of being unable to comprehend the Nepali language. Here I was given a sobering reminder what the priorities of life should be about: where I saw standard-of-care, complexity and guarded prognosis, these patients saw only family to whom they could now tend. I am terribly glad to be reminded that we treat patients not for a mass of data detailing visual acuities and refraction, but for faces recognised, loved ones seen again and for mountain trails walked without stumbling.

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Lilongwi, Malawi January 2013
Dr Rishi Sharma, VR Fellow, Edinburgh
The Kamuzu Central Hospital is the main government run medical facility in Malawi’s capital.  There are estimates of 2.5 to 3 million people living in Lilongwe and this facility is the only one to provide eye care for them.  The Ophthalmology team there is made up of 1 consultant (Dr. Joseph Msosa), 1 registrar, 1 house officer and 9 Ophthalmic Care Officers (OCO). Malawi has a diabetic incidence of nearly 5% (compared to approx 2% in the UK), and as there are no screening or early intervention programmes available, a considerable proportion have significant diabetic retinopathy.  Several patients will present with loss of vision and only at this point will diabetes be diagnosed.  Previous visits to Malawi from staff in Edinburgh had concentrated on clinical treatments for diabetic retinopathy (mainly laser treatment).  However, in assessing these patients it was noted that there was a large proportion of diabetic eye disease requiring surgical intervention (vitrectomy).   Joseph was given basic training in VR work during fellowships in Tanzania and Edinburgh.  The complexity of the cases were far greater than anything most of us will ever see in this country.  We spent the first day examining 40 patients.  All could have done with surgery, but, with the emphasis of out trip being setting up and training Joseph, we managed to perform 14 surgeries over the next 4 days.  The difference we made to these patients and that Joseph is now able to offer subsequent patients was amazing to see. I would very much like to thank the Trustees of the Fiona Dolan Fund for their support in this endeavour. 

Benin, Africa  April 2012

Dr Lik Thai Lim (Specialist Registrar in Ophthalmology, Glasgow) to Hospital St Andre, Parakou, Benin, Africa.

Hospital St Andre De Tinre, a missionary eye hospital is located approximately 12km from Parakou, Benin. The accommodation is very basic, with bed and mosquito nettings, with electricity encountering regular power cuts.  The starting time of work is 8am. Patients come from near and far, some having to travel hundreds of miles to get there. Some patients even have to sleep under mango trees. The SICS which was done are mainly on white mature cataract. Any recordable Snellen visual acuity post-op is considered a success, and the patients are very grateful even though the vision is still poor albeit improvement. Sadly, the presenting complaints of patients with glaucoma and cataract on first clinic visit are the same—reduced vision over months, some even years. This is partly due to poor access to ophthalmology service, and poor patient education. In spite of all these limitations, this eye hospital in Parakou still manages to do its best for all the patients who come.  I managed to perform 25 trabeculectomies and 10 SICS, with good results to date. This  experience made me more aware of the plight of ophthalmic patients in a rural setting with limited resources. I would like to take this opportunity to thank the Fiona Dolan Fund (Glasgow) for sponsoring part of the cost towards this successful trip to Benin.  

 
Indonesia March 2012 
Dr Zia Carrim (Specialist Registrar - Yorkshire School of Ophthalmology) - ORBIS Programme in Surabaya Indonesia.

A unique opportunity came up for me to join the ORBIS team as an Associate Ophthalmologist. This relatively new role allows a trainee ophthalmologist to join the ORBIS Flying Eye Hospital (FEH) team for a short period of time–usually about a week or two–to gain first-hand experience of working in a partnership programme. Being a VR fellow at home, I was fortunate to have the opportunity to work with the visiting VR surgeon. Tuesday to Friday were spent on the ORBIS DC-10 with each day’s activities being centred around surgery. In addition to partaking in pre- and post-operative assessments, I had the opportunity to supervise local trainees on the VR and cataract simulator, give lectures in the FEH classroom and moderate live surgery sessions. There is much to be said for volunteering with an organisation like ORBIS. The fight against preventable blindness on the international scene requires that local stakeholders be empowered. ORBIS achieves this by using a variety of tools including advocacy efforts, hospital based programmes and sponsored fellowships, amongst others.

I am indebted to the Trustees of the Fiona Dolan Fund for generously sponsoring my trip and I dedicate my ORBIS wings to Fiona who, like an older sister, held my hand as I was just beginning my journey in Ophthalmology. Thank you, Fiona! 

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Swaziland May 2011 
Dr Conrad Schmoll ( Specialty Registrar in Ophthalmology – S 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. 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.

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Nigeria October 2010

Dr Rosie Brennan (Consultant Ophthalmologist, Western Health and Social Care Trust, Northern Ireland)
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.        

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Malawi September 2010

Dr Shyamanga Boorah (Specialist Registrar in Ophthalmology, Edinburgh, (SE Scotland registrar rotation) - Nkhoma hospital,  

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. 

Tanzania May 2010 

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.  

 

Comprehensive Community Based Rehabilitation in Tanzania’s (CCBRT) disability hospital in Dar es Salaam
Dr Fook Chang Lam (Specialist Registrar in Ophthalmology, West of Scotland rotation)-Comprehensive Community Based Rehabilitation in Tanzania’s (CCBRT) disability hospital in Dar es Salaam

It is estimated that there are 4.8 million blind people in Tanzania. 75 percent of the blindness is thought to be curable or to have been preventable, while more than 60 percent of children die within one year of becoming blind. My trip to CCBRT was inspired by Dr Tim Lavy-a Consultant Ophthalmologist in Yorkhill Hospital in Glasgow-who is currently working in CCBRT for 1 year.Each day children of all ages and adults present at CCBRT from across Tanzania, some having travelled for days to get to CCBRT. In the operating theatre, I was involved in performing cataract operations, repairing penetrating eye injuries and operating on children with squints, among other procedures. Sutureless manual small incision cataract surgery (SICS) is a fast, low-cost and low complication operation with reliable results and good recovery times. This technique is suited for dealing with blindness from cataract in the developing world as it is less technology dependent and avoids the cost of high-maintenance machinery and consumables associated with phacoemulsification surgery.  I have gained invaluable first hand experience of the healthcare system in Africa from this trip and this visit has exposed to me to the challenges that healthcare professionals in Africa face when trying to care for their patients in challenging socioeconomic circumstances and an underdeveloped national infrastructure.