What changes have taken place in your hospital since the project started?

As a result of the link between your hospital and ours, some positive changes have taken place in our hospital.

1. Our hospital now has a paediatric outpatient and surgical (theatre) days
2. We now have standard and acceptable paediatric visual acuity equipment.
3. Two staff (Augustine Etoh and Thomas Achi) of ECWA Eye Hospital, Kano, Nigeria, have been receiving short term training on proper squint and visual acuity assessment and proper use of the slit lamp for the examination of patients.

What are the future plans for the project and your hospital?

By the end of the first phase of the link programme, we hope that:

1. In ECWA Eye Hospital, Kano, a proper room will be provided for orthoptic examination of children/patients.
2. Mr Thomas Achi (Orthoptic Nurse) and Mr Augustine Etoh (Optometrist) would have been properly trained for a reliable examination/assessment and management of ocular problems in our outpatients.

What has been your impression of Northern Ireland and Londonderry?

Since our arrival in Derry we found the people to be very hospitable. They are always ready to help and are very kind.

All the staff of Altnagelvin Area Hospital that we were attached to are very nice and accommodating. They are always ready to answer any/all of our questions and therefore impart knowledge to us.

They were very patient, intelligent, hard working and always punctual to work.

Northern Ireland (Derry) is a very beautiful place and the beach we visited (near the Giants Causeways) is very beautiful. The Giants Causeway is very wonderful and awe inspiring. Although the food is mainly potato based, we found some of the food very interesting.

The weather at this time is simply glorious and it suited us nicely. In all, Derry and Northern Ireland is a very beautiful and interesting place and we would like to come again.

In conclusion, our many thanks to Dr Rosie Brennan and her team for all that they did for us. God bless you all.

Thank you.

Thomas Achi and Augustine Etoh

24/6/10

Volcanic ash grounded our flights to Kano this April.   We all trudged back into hastily rebooked clinics and lists in the Western Trust instead.   Now we’re looking forwards to our Nigerian counterparts coming here in June and we plan our return visit to Kano in September.

The Western Trust’s Vision 2020 team members are busy making plans for their return visit to the ECWA Eye Hospital. The newest team member, Graham McFarlane, will be travelling with Rosie, Kathleen, Yvonne, Richard and David to Kano from the 17^th to the 24^th of April. Our previous visit in September and the subsequent visit of our Nigerian friends to the Western Trust in November were very useful fact-finding missions designed to help both teams create a training and development program for the dedicated Kano staff. This time we will be spending the whole week working alongside Dr Abuh and his team in clinics and theatres, with the aim of putting this program into action. The work of each team member will contribute towards improving each patient’s treatment journey – from arrival at the ECWA hospital to assessment and management of their condition.

For example, David and Richard will be training three ECWA staff members to accurately assess vision and binocular vision (the ability to use our two eyes together) in children. This information is very valuable to Dr Abuh when deciding how to treat children in his clinics, eg those with cataracts. Meanwhile, Graham will be providing engineering support by carrying out essential maintenance on specialist equipment used in clinics and theatres. Crucially, he will also be training ECWA staff how to carry out this maintenance for themselves. Kathleen will be working closely with the anaesthetic staff in Kano to help with developing their children’s theatre service while Yvonne will be using her skills as a theatre sister to help theatre staff improve their organisation and efficiency with limited resources.

As childhood cataracts make up a significant part of Dr Abuh’s caseload, Rosie will be helping him to develop his service to these patients. Dr Abuh has also requested extra training in the assessment and treatment of patients with squints. David and Rosie will be providing training on assessment while Rosie will also be enhancing Dr Abuh’s surgical skills with these patients. To make the best use of our time in Kano, our colleagues there are currently selecting the most appropriate patients for our week with them. However, having seen first-hand how busy and well-respected the ECWA hospital is, we are sure there will be a few surprises there for us too!

So, the countdown to our visit is on. We’re busy working on our teaching plans and preparing for our journey in April. Most of all, we’re all really looking forward to being back in Kano and renewing friendships with our colleagues there.

It wasn't all work: mid week we went to The Alley in Strabane to hear the Ulster orchestra's Christmas medley

A vital part of the VISION2020 links programme is the visits of team members to each other’s hospitals. These visits allow detailed discussions to take place and ideas are formed when comparing how things are done in the different units. We had been waiting for this visit of the Nigerian team to the Western trust so that the teams could make a detailed assessment of the plans for the 3 years of the programme. We were delighted to welcome our Nigerian colleagues who joined us for the past week (Nov 29 to Dec 5).  Here’s Rosie’s summary of what happened…

Dr Abuh (paediatric ophthalmologist), David Lawal (Anaethetist), Augustine Etoh (optometrist), Thomas Achi (paediatric nurse with interest in orthoptics), John Awah (Theatre Charge nurse) and Maryam Jegede  (theatre scrub nurse) have just spent a week with us in the Western trust.  They arrived in the dark on Sunday evening and left in the dark on Saturday morning.  In between times they spent almost all of the day light hours in Altnagelvin and the Erne Hospital.  They shadowed their counterparts in theatre and outpatient clinics at the beginning of the week.  Then a full day was spent planning the next three years activities.  We detailed exactly what training areas would be addressed, by whom, where, and for how long.  Roughly it works out that each year the teams will visit each others hospitals for between 1 week and 1 month.  The areas that will be addressed are paediatric cataract management, orthoptic assessments and strabismus surgery, efficient use of theatre staff and improved and bio medical engineering support.  In addition it is hoped that a link will be made with a national Kenyan retinoblastoma group to improve retinoblastoma management.

Activity planning session discussions

By the end of the week the rapport between the two teams was fantastic.  We met in September as strangers, having observed one another working in our own environments respect for one another has developed.  We all have a heartfelt enthusiasm for the training programme that lies ahead.

By the end of the activity planning session we'd gained a new team member - Graham McFarland, biomedical engineer

The VISION2020 links programme is not a ‘quick fix’ charity programme. The team aims to help provide training for the staff in Kano eye hospital and help set up a self sustaining eyecare service for children in the area. You can get a feel for the lack of facilities etc. from the reports from the visit.

In developing countries a little money can go a long way. CBM have a ‘virtual gift shop’ with estimated costs for certain procedures. These figures are general estimates and may not be accurate for costs in Nigeria.

In the past, mistakes have been made in funding health programmes in developing countries. Expensive equipment has been purchased, but in some cases it has been underused because it either cannot be integrated with the existing system or cannot be properly maintained.

Our project has been designed to be made ‘fit for purpose’ through face to face meetings between the respective teams. Some of the money for the project will be used to fund the visits of the eyecare teams to and from Nigeria, a vital part of the project. These visits, supervised by the ICEH, will help to ensure that the programme is carefully tailored to the needs of children in Kano and that there are ample opportunities for training the whole multidisciplinary team. Our aim is to help the team in Kano to develop and continue the eyecare programme to help prevent blindness well into the future. The money from the justgiving site will be channeled into the project through an account held by CBM, the charity that supports the E.C.W.A. eye hospital in Kano. This means that admin costs can be kept to the minimum. Further details about how exactly the money will be used to be released after the first Nigerian visit: watch this space!

[Editor: Business buzzwords all in a spin...]

My diary was planned
but never happened.
We were on a mission for a ‘LEAN’.
Who knows what it means?
(Ask the team manager for details)…
It’s about streamlining.
Life in Kano change your tune,
it would have been mean.
Teams should do brain storming on plans ahead for this link.
Oh no… not politically correct, a new buzz word….”thought showering.”

[Editor: back to the future...?]

Went to theatre and spoke to John the local anaethetist expert, done more in a year than in my life time experience.  Shared our thoughts and came up with new ideas together for strengthening our future collaborations. I am in awe how much can be achieved with so little equipment. Go back 30 years and I was back in St Columb’s.  Look forward to seeing David the head anaesthetist and sharing our learning over these 30 years.  Young Kevin I wish you success in your future training as an anaesthetist.  Our world is getting smaller as we realise what an impact we have on one another.  Look forward to this Dr Who experience.

Kathleen Kelly Anaethetist

Visit to Kano – September 2009

Courtesy of the Vision 2020 links programme and thanks to Emirates, we enjoyed a very comfortable and hassle-free journey to Lagos. On arrival, we immediately experienced the heat and bustle of Nigeria and were very grateful for the help of Samuel, a local ophthalmic nurse who arranged transport to the domestic airport and our fourth flight of the journey. The seating allocation system for the plane to Kano appeared to be run by the Nigerian National Lottery and as a result, I was labelled a “bad boy” by other passengers for the duration of the flight!  Once we arrived at the ECWA Eye Hospital, the warmth of our welcome matched the heat of the climate and we enjoyed wonderful hospitality from our hosts for our entire stay. Yvonne was so keen to stay for longer that she mislaid her (and Kathleen’s) passports, which, following a brief panic, were located!

One cataract removed, one to go!

I spent some time with Thomas who is an ophthalmic nurse with a special interest in paediatrics. We had some great discussions around his desire to help develop the children’s eye service in Kano. The clinic is an incredibly busy place and I got the chance to see a number of patients there with Thomas and demonstrate some basic orthoptic techniques to him. It was at these times that I realised what an impact lack of equipment can have as I struggled to assess children’s vision without the tests which I take for granted in the Western Trust. I talked Thomas through the use of what equipment he had and suggested how he could make adaptations to these tests. Currently there is no orthoptist anywhere in Nigeria and I believe that training someone to have these skills would be of great benefit to the eye care provided in Kano. Over the next three years, I hope to develop and carry out a training programme to enable staff to deliver a basic but competent orthoptic service to the patients at ECWA Eye Hospital. This will involve developing skills in vision testing (particularly in children); detecting and measuring squint/strabismus; ocular movement testing; and binocular vision assessment. I look forward to this challenge and I’m confident that it can be achieved – with some hard work and co-operation in both countries!

David Wright.   Orthoptist