In 2004 Dr Abuh, Medical Director of ECWA Eye hospital, Kano, requested a link through the VISION 2020 links programme run by the International Centre for Eye Health. He wanted to develop his paediatric ophthalmic service – improving management of paediatric cataracts, developing his team’s skills in performing orthoptic assessments and visual acuity measurements in children, and enhancing his own strabismus surgical skills. In 2008 Mrs Rosie Brennan asked ICEH to find a VISION 2020 link partner for WHSCT. The two institutions were considered a potentially suitable match and in Sept 2009 six people from the WHSCT made a Needs Assessment visit to ECWA Eye Hospital, Kano. This group comprised a senior manager, an anaesthetist, an orthoptist, an optometrist, an ophthalmologist and a theatre sister. A return visit of a team of six from ECWA came to the WHSCT December 2009. This group comprised an ophthalmologist, an optometrist, an anaesthetic nurse, the theatre charge nurse, a theatre nurse and an orthoptic nurse. The Needs Assessment phase of the link was completed, a three-year activity plan was devised and an MOU signed.
In June 2010 a team from ECWA Eye Hospital, Kano visited the WHSCT Eye Department, Northern Ireland. An orthoptic nurse and optometrist stayed for one month and received training in paediatric visual acuity and squint assessment.
A return visit by a team of six from the WHSCT was arranged for the 11th September 2010. A biomedical electrical engineer and a new orthoptist joined the original team from September 2009.
Significant progress has been made since the commencement of the programme in 2009. As a result of the link programme ECWA Eye Hospital now has:
- Improved surgical technique and confidence in decision making regarding squint surgery.
- An orthoptist/ophthalmic nurse and an optometrist trained to assess visual acuity in children to a satisfactory level using a range of age matched acuity tests.
- An ophthalmic nurse trained in stereopsis assessment, how to perform a prism reflex test, cover test, prism cover test and how to assess ocular movements.
- Paediatric general anaesthesia lists identified for two days per week and a recovery nurse appointed.
- Improved theatre organisation with various delegated responsibilities among the theatre nursing staff.
- A modified version of the WHO surgical safety guidelines in place.
- A visual fields nurse trained in appropriate use of visual field testing equipment.
The addition of our medical engineer was a great bonus to the project. A large quantity of damaged equipment was repaired and equipment in storage was made functional for use. In partnership with the resident technician further work and long term training objectives have been planned.
At the end of the September 2010 visit both surgeons attended the Kenyan National Retinoblastoma Strategy group conference. This gave Dr Abuh and Dr Brennan ideas on how to attempt to improve the high mortality rate seen in Nigeria for children with retinoblastoma. Currently the key to change the outcome is to catch the cancer when it is confined within the eye. At this stage enucleation (eye removal) is curative. Now we have made up an awareness poster encouraging early presentation. 5,000 copies in three different languages will be distributed by Vision 2020 workers in the states neighbouring Kano. We also hope to make a video to show to parents whose child has intraocular retinoblastoma. This video will feature parents of children who have survived and those who have not emphasing the importance of early intervention.
We have now completed our second year of activities with a visit to Kano by 5 in January and a visit to Londonderry by 6 in June. Audits have been carried out looking at paediatric cataract surgery outcomes and retinoblastoma treatment outcomes in 2008, the year before the link started. We plan to reaudit these areas in 2012 to assess the effect of the changes made.
While the activities plan has formed the framework of the timetables we’ve made for our visits, we’ve found that some areas have receded in importance and other areas that we hadn’t planned to cover initially have been addressed. For example bleb needling with 5 FU to restore functionality to a failing trabeculectomy (glaucoma operation), and varifocal lens fitting have been taught.
We look forward to further mutual visits in 2012, the third year of our link.
Please see our website www.vision2020kano.org for our reflections on the visits so far, photos including our retinoblastoma awareness poster, and details of our fundraising activities.
Dr Abuh Sunday Omogani
ECWA Eye Hospital
PO Box 14
Tel: + 234 8060297605