Focus on the training of eye surgeons

Parked on the tarmac at Dar es Salaam International Airport, the ORBIS aircraft initially seems indistinguishable from any other large jetliner. Even a quick glance inside its fuselage reveals nothing immediately extraordinary.

Yet, in what is normally the first class section of the aircraft, some 50 people are seated and staring at a large screen that suddenly flickers into life. The camera zooms in on its subject that seems strangely out of place with the setting.
These viewers are not passengers about to watch an in-flight movie. They are ophthalmologists from across Tanzania observing a filmed cataract operation aboard a DC-10, which has been converted into a modern flying eye hospital.

The idea was conceived in the mid-1970s by Houston ophthalmologist David Paton, a flight safety specialist and philanthropist. Having discussed the worldwide scourge of blindness, especially in the developing world, ophthalmologists created the mobile teaching eye hospital called ORBIS.

"Specialist training in this sort of field is only really available at a great expense. So the originators of ORBIS created a way of bringing the training to where it is needed most," Dr Gordon Douglas, the Canadian consultant conducting the operation and training the Tanzanian ophthalmologists, said.

Shortage of skills

With only 25 eye specialists for a population of 36 million people, Tanzania is a country badly in need of this type of training. As it has done in over 70 countries over the last two decades, ORBIS landed in Tanzania a month ago and set up its mobile eye surgery and training facility.

Over the course of the month, the team has provided training in surgical skills and nursing support to Tanzanians health workers. Also, biomedical engineers have been instructing local hospital staff in equipment maintenance and repair.

Ministry of Health statistics show that in Tanzania some 350,000 people are blind and 700,000 others with poor vision risk losing their sight, permanently. But, as is the case the world over, the knowledge and technology exists to prevent 80 percent of these cases, so the training that the 170 eye care professionals received will be much appreciated, local doctors say.

"It is a socioeconomic burden having so many blind people as these people need to be constantly taken care of and can't help the country develop," Dr Simon Katenga, an eye specialist at Dar es Salaam's Muhimbili National Hospital, said after completing a glaucoma operation under Douglas' guidance.

Evaluating of the benefits of ORBIS to Tanzania, Katenga said the nation had received equipment and that new operation techniques had been introduced.

"When the plane takes off, we will be able to continue the job," he said.

Facing challenges ahead

Half the eye related problems these local surgeons must deal with are cataracts, 20 percent are corneal scars caused by trachoma and vitamin A deficiency, and 10 percent are glaucoma. The remaining 20 percent of blindness problems, however, are not preventable or easily treated by existing technology, the ministry says.

Ophthalmic nurse Roger Aluli said he would be able to pass on knowledge he had learnt at ORBIS on assisting in operations.

"When I get back to the hospital, I'll make some changes, bring things up to date and teach my colleagues so we can tackle blindness here," he said.

Similarly, Dr Anna Sanyiwa, a surgeon at Muhimbili, said the combination of more modern equipment and skills would make a huge impact on the services that the government could provide.

"With the new equipment and, more importantly, the new skills, I am going to teach junior doctors that weren't able to take part in this trip," she told IRIN.

Long-term relationship

OBIS handed over to Muhimbili Hospital US $17,000 worth of assorted equipment used for diagnosis of eye diseases. The hospital, the country’s sole referral medical facility and training centre for eye doctors, is the only recipient of donations from ORBIS.

This was the first time the ORBIS had visited Tanzania, but Dr Arvind Chandna, another visiting consultant, said that the aim should be for Tanzania and ORBIS to enter into a three-to-five-year partnership with ORBIS on programmes targeting paediatrics, glaucoma and small incision cataract surgery, the main eye problems in the country.

"We've had great success in Ethiopia and Bangladesh doing these five year programmes," he said. "For example, in Ethiopia, with the help or ORBIS and Sight Savers, legislation has been changed and everybody's cornea is donated when they die."