I was fortunate enough to undertake an eight-week ophthalmology elective at the Kilimanjaro Christian Medical Centre (KCMC) in Moshi, Tanzania. It was an unforgettable two months, filled with once-in-a-life-time experiences and also the opportunity to gain invaluable clinical knowledge. KCMC is a large referral and teaching hospital which provides specialised care to a wide catchment area.
Therefore, they face the strain of high-patient volume with limited resources. I wanted to do my elective in Tanzania to experience the challenges of providing eyecare in a different healthcare setting to what I am used to. And it was a bonus that I got to see Mt Kilimanjaro up close on my daily commute!
In KCMC, the structure of the eye hospital was not too dissimilar to what I had experienced in England. My working week was a mix between clinics, which ran all week and theatre sessions every other day. Many of the procedures I witnessed followed similar procedural steps to what I had seen on my medical school ophthalmology placement. The departments varied in funding dependent on if they were funded by charitable organisations or by private donors. Furthermore, the eye department seemed to be well funded in comparison to other departments.
There were also many differences. For starters, there was an eye ward managed by two resident doctors. This was mainly for patients who had travelled from outside of Moshi as KCMC is their nearest referral hospital. Therefore, patients who were travelling from many hours away for a surgery would need somewhere to stay in order to have an appropriate postoperative check-up. The postoperative ward round would take place in rooms on the ward where patients would come in one by one to be assessed.
I noticed that the turnover from clinic to theatre was much quicker in KCMC than in the UK. Most patients would be booked in for theatre the same week they had arrived for their appointment, and for emergency cases they would be sent to theatre straight away. Theatre sessions were an interesting experience and I was able to observe paediatric surgeries, cataracts and vitreoretinal operations. There was a high volume of cataract surgeries taking place every day and in order to tackle this, the operating room had five patient beds with multiple residents present with each patient so I was able to witness five cataract surgeries being performed at the same time! This is a stark contrast to the UK where cataracts are done one patient after another in a theatre room that has been cleaned between each case. Once the procedure was completed, a resident doctor would guide the patient to a recovery room and would bring in the next patient themselves. In the paediatric operating room, I was able to observe surgeries for retinoblastoma which is one of the most common childhood cancers in Tanzania. If the retinoblastoma was progressed, they would remove the child’s eyeball in theatre which was a surreal experience.
During my time in the eye department, one thing that had become apparent to me was that I was witnessing many more cases of advanced eye pathology than I was used to. Many patients arrived to clinic already blind and the doctors would have to tell them that there was no intervention available for them anymore. This made me reflect on the barriers these patients face when accessing eye care. Firstly, if a patient was from a rural area, KCMC may be the closest hospital to offer them specialist services but it may be hours away from their home. Patients are often brought to the hospital by their children as their vision is too impaired to be able to guide themselves. Another reason may be financial strain. You have to pay for treatment at KCMC and therefore those patients who are not part of any national insurance schemes may have to pay out of pocket and therefore, might avoid coming to the hospital. In addition to this, some patients are unaware of the effects of systemic conditions such as diabetes on other systems and may not have the necessary health education to be able to take ownership of the microvascular complications that lead to diabetic retinopathy.
Diabetic retinopathy is a preventable cause of blindness and routine screening can mean that patients can have laser therapy when it is indicated and prevent blindness. Routine appointments are often scheduled for the patients but they can choose not to attend these. I appreciate the dedication of the ophthalmology team to continue to bridge this gap and reduce cases of preventable blindness. A screening programme is being developed at KCMC using AI to help screen for diabetic retinopathy. This is a great step in order to begin tackling this issue.
“...remain unjudgmental and understand a patient’s story […] as there may be multiple factors that are affecting their ability to receive care”
This elective has deepened my understanding of these issues and global health challenges as a whole. It has taught me that although the infrastructure for treatment may be in place, there are many factors that affect a patient’s access to treatment. I will take home the importance of recognising health inequalities which exist both in Tanzania and in the UK. I will also remember to remain unjudgmental and understand a patient’s story, even if they are coming for an eye check-up as there may be multiple factors that are affecting their ability to receive care.
I would recommend an elective in Tanzania to anyone who is looking for an opportunity to see some interesting eye pathology that we do not often come across in the UK. Furthermore, Tanzania is a vibrant and beautiful country with some of the most hospitable people I have ever met. During free time there is plenty to do such as wildlife safari’s and day walks up Mt Kilimanjaro. There is something for everyone from the relaxing beaches of Zanzibar to experiencing the beauty of the rainforest in Materuni or the stunning mountain views on Usambara mountain. Whatever you are interested in, an elective in Tanzania is an opportunity for a fulfilling and well-rounded experience.
Declaration of competing interests: None declared.
