FEATURE

Ophthalmology in the developing world

BY C DAL COL

fter the second year of The HEALTH-AID Centre located medical school, I spent my in Saboba, Ghana. summer vacation working Aas a volunteer for a small Italian non-government organisation (NGO), named HEALTH-AID. As part of my volunteering experience, I joined a team of European doctors, medical students and nurses who provided free healthcare to Ghanaians living in deprived areas in the Saboba-Chereponi District in Northern Ghana. HEALTH-AID is a privately funded NGO that aims to support Ghanaians who are unable to afford the membership of the National Health Insurance Scheme (NHIS), which was implemented in Ghana in 2004 [1]. The NHIS was designed to ensure access to basic healthcare services to all Ghanaians. Unfortunately, not all inhabitants are able to afford the annual membership fee, which roughly converts to 10 GBP. As a result, a healthcare via a drop-in system. Capacity building in Ghana relatively large number of Ghanaians Secondly, each day a team of doctors However, the focus of HEALTH-AID is struggle to receive even the most basic and nurses travels to more remote not merely the provision of healthcare healthcare services, especially in the villages via outreach programs. I was to deprived areas on an ad hoc basis, more rural regions in the North. One lucky enough to be able to participate but importantly, the organisation example that I repeatedly encountered in both types of interventions. Some also targets capacity building. The during my volunteering work was the consultations were very rewarding NGO aims to have a more sustainable lack of hepatitis B immunisations. It as we were able to provide adequate and far-reaching impact by providing is estimated that 15.6% of Ghanaian treatments or reassure anxious patients. health education. Personally, I was children may be infected with the However, the experiences I had were involved in delivering workshops to hepatitis B virus [2] and similarly, many also difficult at times as our resources Ghanaian teachers and high school of our very young patients tested positive were limited and there were many students and travelled to local villages for the infection. I was alarmed to learn patients whom we could not help. to deliver speeches and facilitate that this high prevalence existed despite Unfortunately, our stock of medicines discussions within the community. the implementation of the ‘Expanded was restricted and consisted primarily of These ‘health topics’ were quite varied Programme on Immunization’, which antimalarials, antibiotics and analgesics. in nature and included the prevention aims to vaccinate all pregnant women Accordingly, during our consultations of HIV, hepatitis B and malaria; the and children against the virus on a at the health centre and the outreach importance of hygiene; and the national level [3]. programmes, we encountered numerous treatment of dehydration. These patients who could not benefit from our teaching opportunities proved to be Working for HEALTH-AID limited resources. At times, I found this very enjoyable. On some occasions, my HEALTH-AID provides immediate experience very challenging, as it was health talks about the use of condoms healthcare services to a deprived patient frustrating to come to the realisation in the prevention of HIV/AIDS sparked population by two means. Firstly, that our efforts remained merely a drop passionate debates between male and HEALTH-AID volunteers provide free in the ocean. Even though I knew that female groups of villagers and I was very consultations and treatments in the we did help some patients, it was very grateful to be a part of these dynamic Health-AID Centre, which is based in difficult to leave Ghana, knowing that exchanges. However, the interaction Saboba. Patients from neighbouring there were so many more patients who with the villagers also gave me a better villages travel to the clinic to receive we could not help. understanding of the obstacles the

eye news | APRIL/MAY 2014 | VOL 20 NO 6 | www.eyenews.uk.com FEATURE

people encounter, which prevent by inviting AL Ueltschi, the founder of them from implementing our health FlightSafety International, onto the recommendations. The experiences I had team. AL Ueltschi, Betsy Trippe and Dr during these workshops and speeches Paton then mapped out a plan, which were some of the most rewarding and laid down the foundation for ORBIS valuable ones as they gave me the feeling International. The team secured an that I contributed to laying down the airplane, which was donated by Eddie groundwork for improving the health of Carlson, Chairman of United Airlines. their community in a more sustainable The airplane was converted into a way. Therefore, even though we left so fully functioning teaching eye hospital many people without treatment, I was with a grant from the US Agency for able to leave Ghana with the feeling that International Development (USAID) and our team contributed to a better future The six key components of ORBIS International. funds from private donors. In 1982, the for their community. Reprinted with permission from ORBIS International. aircraft took off to Panama for its first training mission. in the During the first two years of ORBIS developing world to the elimination of the causes of International, the crew flew to 24 I am glad to have seized the opportunity avoidable blindness. ORBIS works with countries and largely focused on the to gather volunteering experiences its local partners to establish sustainable transfer of surgical skills. The year in the developing world as a medical eye care in , , , 1984 marked a turning point in the student. However, I believe that as a , Latin America and the Caribbean, history of ORBIS, as the flying eye doctor, I can be more actively involved , and . The hospital launched a program in Africa, in capacity building, as I will be able organisation treats cataracts, diabetic where there was a severe lack of to use my skills and knowledge to retinopathy, glaucoma, retinopathy of trained ophthalmologists. Accordingly, deliver more targeted teaching and prematurity, strabismus and trachoma. ORBIS expanded its mission to not therefore contribute to projects, which only focus on teaching surgical focus on capacity building in deprived The History of ORBIS skills to ophthalmologists but also communities. One of the many reasons International enhancing the skills of the broader why ophthalmology is such an attractive The story of ORBIS International ophthalmic community. Specialised career option is that there is ample begins in 1973, when Dr David Paton training programs were targeted at opportunity to deliver healthcare to first envisioned a flying eye hospital. Dr ophthalmology assistants, nurses, populations in need and to contribute Paton, the head of the ophthalmology public health workers and biomedical to the improvements of ophthalmic department at Baylor College of engineers, who played a major role in institutions in developing countries. The Medicine in Texas, had extensively providing eye care services. World Health Organisation (WHO) states travelled throughout the developing In 1985, ORBIS further broadened that 285 million people worldwide are world as a visiting faculty member its scope by launching more and more visually impaired and that 90% of these and was concerned over the state of programs without the plane. ‘Off the live in developing countries. Globally, ophthalmic services and teaching in plane’ surgical, nursing and community the main causes of developing countries. He observed that programs were launched in countries are uncorrected refractive errors, whilst most doctors and nurses in developing that had been previously visited by the cataracts remain the leading cause of countries could not afford the high plane or were not easily accessible by blindness in low and middle income costs of tuition, international travel and plane. Another milestone was reached countries. Notably, 80% of all visual accommodation that are involved in in 1986, when ORBIS strengthened its impairment can be cured [4]. ophthalmic training. Dr Paton’s solution focus on the prevention of blindness was a mobile eye hospital, which allowed and public health. To promote eye care The International Agency doctors to bring their knowledge and as an integral part of overall healthcare, for the Prevention of skills to their colleagues in developing a community health department was Blindness (IAPB) and ORBIS countries through lectures and hands-on created at ORBIS headquarters, and international experience. community eye care programmes Dr Paton shared his idea with his good The IAPB was established in 1975 as were established. In the late nineties, friend and college classmate, Betsy a leading umbrella organisation to permanent ORBIS offices were launched Trippe DeVecchi. In turn, Betsy sought co-ordinate the international efforts to in Ethiopia, Bangladesh, China, India the advice of her father, Juan Trippe, the prevent blindness. In collaboration with and Vietnam. These offices are run founder of the Pan American Airways. the WHO, a global initiative was founded, by local staff and aim to improve the Mr Trippe turned the idea into reality VISION 2020: The Right to Sight. ORBIS quality and accessibility of eye care International is a key organisation within the IAPB Council of Members that targets some of the world’s most under-served areas. It aims to strengthen local eye care institutions, introducing ophthalmic technology, training local staff, increasing public awareness about eye health, and advocating for supportive policies [5]. ORBIS International devotes itself The Flying Eye Hospital. Reprinted with permission from ORBIS International.

eye news | APRIL/MAY 2014 | VOL 20 NO 6 | www.eyenews.uk.com FEATURE

to local residents. The projects are run with colleagues in developing countries 3. Ghana Health Service: www.ghanahealthservice.org/ epi.php Last accessed February 2014. throughout the year and many focus through surgical demonstrations, wet lab 4. Fact Sheet N°282. The World Health Organization. on the treatment and prevention of supervision, consultations, lectures and www.who.int/mediacentre/factsheets/fs282/en/ Last childhood blindness, cataract, trachoma workshops. ORBIS are always looking accessed February 2014. and corneal disease. for qualified and motivated eye care 5. The International Agency for the Prevention of Blindness: www.iapb.org Last accessed February professionals for a wide range of both 2014. Capacity building medical and non-medical positions. 6. ORBIS International. www.orbis.org.uk Last accessed February 2014. Capacity building is one of the key Opportunities include specialised elements of ORBIS International. The ophthalmologist, ophthalmic nurses, organisation aims at building long-term anaesthetists, biomedical engineers, capabilities of ophthalmic institutions in ophthalmology residents and fellows. developing countries. This is achieved by Please see the ORBIS webpage for collaborating with NGOs, community- more information about the application based organisations and the private process [6]. sector, as well as local and national governments. The ultimate goal is to reach a state, where the partner country Acknowledgements can independently provide quality eye The author would like to thank ORBIS for allowing the use Caterina Sarah care. There are six key components to of information published on their website. Dal Col, BA, BSc (Hons), ORBIS’s capacity building efforts, as References Fourth year medical student, shown in the diagram. 1. Sodzi-Tettey S, Aikins M, Awoonor-Williams JK, University of Agyepong IA. Challenges in provider payment under the Ghana National Health Insurance Scheme: a case Manchester, UK. Getting involved study of claims management in two districts. Ghana E: caterinadalcol You can help to save sight on board the Medical Journal 2012;46(4):189. @gmail.com. ORBIS Flying Eye Hospital or through 2. Blankson A, Wiredu EK, Gyasi RK, et al. (2005). Sero- prevalence of Hepatitis B and C viruses in cirrhosis Declaration of Competing Interests: None declared. a Hospital Based Programme. Medical of the liver in Accra, Ghana. Ghana Medical Journal volunteers can share their expertise 2005;39(4):132.

eye news | APRIL/MAY 2014 | VOL 20 NO 6 | www.eyenews.uk.com