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

Journey
An uneventful journey made effortless by Marcia’s contacts and ‘fixers’. Luckily the in-flight food was satisfactory as Yvonne was not overly keen on purchasing the goat’s head soup or peppered snails at Lagos Airport. Rosie’s attempts at sleeping included a variety of yoga like seating positions which caused much amusement.

Accommodation
Basic but pleasant guest house accommodation. We were woken one morning by the half hour severe flogging of the next door neighbours dog who apparently had consumed its owner’s rather plump turkey – an important economic commodity. When we commented on the brutality of this beating to one of our hosts they replied ‘this country has to sort out its human rights before sorting out its animal rights’. I did wonder which was worse however – the yelping of the dog or David’s snoring.

Work
The whole basis of our role is to provide education and a support network for clinicians who are otherwise working in isolation. Our hosts were well educated but lacked some modern techniques and skills which it is hoped this link will provide.

Pathology
I was given my first introduction to the complications of ‘couching’. This is a very primitive and crude technique to treat mature cataracts. Although obsolete in the Western World since 1750, it is still common in Northern Nigeria where it is carried out by local traditional eye healers using a large thorn or unsterile ‘couching’ needle and a very ‘secret herbal solution’ known only to the couchers. The procedure is often not effective and can cause a painful blind eye. Patients present at this stage to ECWA eye hospital. If you’d like to find out more, here’s an interesting article on ‘couching’ by the way.

Having listened to the medical staff in the clinic, it was apparent that patient education will be as important as clinic throughput if blindness is to be significantly reduced in Nigeria.

Outpatient waiting area

My enduring memory will be of seeing a very sick child lying on a dilapidated hospital bed dying from the effects of retinoblastoma, an ocular cancer. The child had been abandoned by his mother who could not afford his upkeep and his father who considered him an embarrassment.

The ward had 20 beds and due to frequent electrical cuts had no fans for ventilation in the searing heat – truly horrendous. Relatives of patients admitted to the wards also cooked in the wards as the hospital is unable to provide food. Patients arrived at the hospital having travelled for almost a day and slept in the corridors until clinic resumed at 7am the next morning. One patient I spoke to had travelled 10 hours by car to get to the clinic. This was both a reflection of the lack of eye services in this country and a measure of the high regard Nigerians have for Dr Abuh and his team.

Nigeria
In some respects Nigeria’s image problem is not dissimilar to Northern Ireland’s of the past. Its dangerous reputation does not portray to the outsider the true reality of the warmth and generosity of its people. Everyone we met, from hosts to patients through to people we met on the streets, were extremely courteous and welcoming and our initial paranoia and nervousness quickly diminished.

However, there was no disguising the extreme poverty of this country. We were shown photos of the villages where the hospital staff travel to provide outreach clinics. The photos evidenced the lack of basic amenities which westerners take for granted. Poor sanitation also aids the spread of the blinding condition trachoma.

Compiled by Richard Gilmour, Optometrist

Our 32 hour journey to Kano involved a dogs leg to Dubai. Apart from a forgotten yellow fever certificate brought at speed to the airport by a dedicated spouse, the journey was uneventful.

Western trust team with 3 of the 4 ECWA doctors

ECWA eye hospital in Kano has a total of 126 staff including 4 doctors, 20 nurses, 7 administrative staff and 25 cleaners. Kano has a population of 7 million. Nigeria, a population of 149 million. In the Western Trust patients can travel up to 100km for treatment. In ECWA some patients had come 1,500km! Dr Abuh, the paediatric ophthalmologist draws these patients from far and wide for treatment of such conditions as childhood cataracts, retinoblastoma and glaucoma. There’s a screening programme by CBM for paediatric cataracts reaching the poorest of the poor. I saw many patients they’d referred with bilateraly blinding cataracts allowing only light perception vision. The absence of nystagmus (wobbly eyes) suggested these cataracts were likely to be developmental rather than congenital. After surgery these children were moving around independantly. I watched a 6 year old girl who had been blind for 4 years exploring the room with wonderment.

Dr Abu is keen to offer a service “that would be good enough for his own child”. He has been requesting a VISION 2020 link for 5 years. He has a clear idea of the areas that he wants to improve upon. Our visit allowed us to see their case mix and watch how the clinics and theatre sessions were conducted. In late November a team from ECWA eye hospital will visit us in the Western trust. At the end of their week with us, we’ll draw up a 3 year activity plan detailing the training programme we’ll conduct. I think the collaboration will be fruitful for both departments.

Compiled by Rosie Brennan, Paediatric Ophthalmologist

A number of supporters join in for the final leg

How many of the cyclists can you identify? We met up at the North Pole Bar in Dumfries (North of Buncrana). Hilda had made some sandwiches to provide some much needed energy for the final leg of the trip.

Some had cycled from Strabane, some from Derry/Bridgend and some started in Dumfries. Rosie, Chris and Patrick were also supported by the motorcycle ‘marshals’ who kindly helped keep the cyclists safe.

At the end of the cycle we had tea and goodies – thanks to all who helped. Thanks also are due to the staff at Halfords (Crescent link) for providing Martina with some free goodies which we gave to the cyclists at the end of the trip as a little reward for their efforts.

Martina (who drove the team down to Cork and supported them on days 1-4 of the cycle) has put together a little fun video about the trip from Mizen to Malin. See what you think of it!