Wachemo University campus.
The Ethiopian Government is well aware of the brain drain amongst health workers and, to compensate, is training huge numbers of medical students, nurses and health officers in universities like Wachemo, a massive new University near Hosanna town in South West Ethiopia.
Through the VISION 2020 LINK between Hosanna Hospital and our District General Hospital of Glan Clwyd we heard in 2013 that Wachemo University was seeking visiting teaching support and we were able to offer a one-week course in ophthalmology. Our team included Claire Morton, a Consultant Ophthalmologist from Abergele, Luke Nicholson and Tom Betts, Senior Trainees on the Wales rotation.
On our training visit, the team learned how to say hello, look up, look down and thank you in Amharic, Ethiopia’s official language, but not much more. However, mention the names Rooney, Dzeko or Suarez to any Ethiopian and an animated discussion begins and conversation develops. Enthusiasm for Premiership football is everywhere. We split our 82 University students into Premiership teams when asking them to prepare presentations on visual acuity, the pupil, cover test and visual fields. Despite a lack of resources in ophthalmology care in their home clinics and hospitals, these nursing and health officer students rose to the challenge and really impressed us with their desire to learn and share knowledge. They are some of the first students from Wachemo University.
Classroom teaching was supplemented by practical sessions at the local hospital, teaching fundoscopy and anterior segment examination using the excellent solar powered Arclight ophthalmoscopes. These newly invented ophthalmoscopes had been kindly donated by the Fred Hollows Foundation and are perfect instruments for sunny Africa. We also had the opportunity to join cataract surgeon Ato Zelalem as he performed – to a very high standard – small incision sutureless cataract surgery (SICS). Zelalem is one of a batch of nurses who have been trained as cataract surgeons. We were pleased to receive some very gratifying evaluations.
VISION 2020 LINK with Hawassa Hospital
After a three-hour drive south we arrived at our VISION 2020-linked hospital – Hawassa College of Health Sciences – and met up with our two nursing colleagues, Sister Lorraine White and Nurse Mark Francis from Stanley Eye Unit, Abergele. Our second week was to be spent teaching third and fourth year optometrists in clinical assessments and supporting Paediatric Ophthalmologist Dr Emebet Girma.
“Retinoblastoma is a highly curable cancer in the UK; in Ethiopia it is currently a death sentence for most children affected by it.”
Optometrists carry out much primary medical and surgical eye care in Ethiopia and are highly trained. They particularly valued teaching in slit-lamp usage, field testing and indirect ophthalmoscopy. Our senior nurses Lorraine and Mark also taught theatre procedure and sterile technique as well as keratometry for biometry.
Examining children with the students was a learning exercise for both us and them. We were challenged by many complex cases of conditions such as congenital glaucoma, severe hyena injuries, anterior staphyloma, scleritis and a case of possible tuberculous dacryoadenitis. The results of our challenging end-of-week test will help Dr Emebet to assess her students and we were glad to be able to award Arclight ophthalmoscopes to all the students, as well as some highly valued textbooks.
VISION 2020 LINKS between Ethiopia and North Wales – the history
“This VISION 2020 LINK developed as an off-shoot of an existing THET link between Hosanna Hospital and Glan Clwyd Hospital run by Paediatrician Dr Duncan Cameron. While visiting with a team to Hosanna in 2007 I met up with Dr Abu Beyene of Yirgalem Hospital. He was keen to set up a VISION 2020 LINK with his base hospital in 2009. This was formalised in 2009. More recently we have extended to Hawassa, where Ophthalmologist Dr Emebet Girma is keen to develop children’s eye services and formalised LINKS here as well. The main priority is the development of children’s eye care in Hawassa and includes tackling the issue of retinoblastoma.”
Claire Morton, Consultant Ophthalmologist, Stanley Eye Unit, Abergele.
Retinoblastoma in Hawassa
During our one-week visit we were saddened to see five children with advanced retinoblastoma. Retinoblastoma is a highly curable cancer in the UK; in Ethiopia it is currently a death sentence for most children affected by it. Children present late, often with gross orbital disease and ophthalmologists feel obliged to carry out exenteration but with minimal hope that the child will survive.
With input from Daisy’s Eye Cancer Fund [1], and expertise from the Hospital for Sick Children in Toronto [2], Kenya has developed a National Retinoblastoma Strategy and an annual Conference is held in Kenya to develop this strategy and promote good practice. Last year our LINK funded the attendance of an ophthalmologist and a paediatric nurse from Hawassa at this conference. We wanted to build on that experience this year by arranging a retinoblastoma workshop for Hawassa medical and management staff.
Twenty-nine invited delegates attended this meeting in Hawassa with talks on the nature of the disease, its presenting features and its treatment, together with a presentation by Lorraine White on counselling and breaking bad news. The delegates then discussed issues such as public awareness, improving medical knowledge, standardising pathology and introducing chemotherapy at Hawassa.
Nurse Mark Francis teaching autorefraction to optometrists at Hawassa Hospital.
Children at the blind school enjoy the feel of Tom Betts’ beard.
Involvement with local blind school
Our VISION 2020 LINK with Hawassa Hospital includes support for the local blind school at Shashamene. This school looks after 92 blind children and provides them with an excellent education. A visit to the school demonstrates that corneal disease is still a major cause of blindness in Ethiopian children, with malnutrition often a contributory factor. The children are taught Braille in English and, as well as academic teaching, they receive training in life and farming skills such as distinguishing different grain sizes. The girls sing beautifully and the boys amaze us by their skills with a football, either one with a bell inside, or a ball with a plastic bag tied round to make an audible swishing sound.
VISION 2020 LINKS Programme aims to reduce unnecessary deaths due to retinoblastoma in Africa
Every year, thousands of babies and children in Africa lose their sight and their lives to the childhood eye cancer retinoblastoma (Rb). In contrast, more than 90% of children in the Western world with Rb survive, due to early diagnosis and specialist treatment [3]. The UK-based VISION 2020 LINKS Programme is uniquely placed in Africa with a total of 18 paediatric LINKS in 12 countries, including a LINK between Hawassa, Ethiopia and North Wales. The LINKS Programme wants to help these paediatric LINKS find funding to work together as a Network to reduce the number of children’s lives lost unnecessarily to Rb.
With the 18 VISION 2020 LINKS partnerships, the LINKS Rb Network plans to find funding to:
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Train specialist multidisciplinary teams, country by country.
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Develop an international network (‘community of practice’) with paediatric ophthalmologists, pathologists and oncologists, to share learning and best practice across 12 countries.
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Improve health worker awareness through a programme of training workshops for eye health workers.
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Address community awareness through radio and TV broadcasts, posters in health centres.
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Develop evidence to be shared with, and used by, other countries.
Ethiopian team visit to the UK
In June this year we hosted a training visit for Dr Emebet together with her colleagues Optometrist Ephrem Kite and Ophthalmic Nurse Abdelfeta Kedir. During this visit the team observed ocular surgery, eye casualty, children’s eye clinics and even an afternoon of mandatory fire and CPR training. Dr Emebet was invited to the BOPSS meeting in Liverpool for a day where orbital and lacrimal surgery were on the programme. Abdelfeta joined our orthoptists to achieve his aim of improving skills in assessment of children’s vision and strabismus management. Ephrem spent time with Optometrist David Fisher, training particularly in low vision aids. He is keen to put into practice his low vision skills in the blind school at Shashamene. All the team were very appreciative of the learning gained through the visit, which can be used back in Hawassa to improve care and treatment of patients.
“Corneal disease is still a major cause of blindness in Ethiopian children, with malnutrition often a contributory factor.”
We are very grateful to the Welsh Government for the grant we have received to help with our VISION 2020 LINK, enabling us to teach and share skills with the whole eye care team. The surgery we have witnessed in Ethiopia has been fast and of high standard so we feel strongly that the greatest contribution we can make is not in theatre but in the teaching arena – to ophthalmologists, optometrists, nurses and health officers and next time medical students.
If you enjoy teaching and travel you may wish to consider taking part in your hospital’s VISION 2020 LINK or perhaps establish a new partnership with the help of the VISION 2020 LINKS team at the International Centre for Eye Health [4].
Oh, and in Africa a bit of familiarity with Premiership football helps a great deal!
References
1. Daisy’s Eye Cancer Fund.
www.daisyfund.org
Last accessed June 2014.
2. Hospital for Sick Children, Toronto.
http://www.sickkids.ca/
Last accessed June 2014
3. Fighting for Life and Sight in Ethiopia. A Human View.
http://humanview.org/2014/
05/20/eye-cancer-next-steps/
Last accessed June 2014.
4. VISION 2020 LINKS Programme.
http://iceh.lshtm.ac.uk
display/WEB/VISION+2020+
Links+programme
Last accessed June 2014. Wachemo University campus.
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