Carla Jauregui:
Empowering physicians to help provide sight-saving surgery

Understanding the disconnect between patient needs and available treatment

Recent estimates from the World Health Organisation suggest that over 6 million people in Africa are blind and a further 26 million have visual impairment. In Sub-Saharan Africa, cataract is the leading cause of visual impairment, accounting for around half of all cases.

Manual small-incision cataract surgery (MSICS) has been designed considering low income settings, such as Africa. The surgery is relatively straightforward and cost effective; however, key challenges prevent optimal outcomes:

  • Critical shortages of skilled eye health workers limit access to and success of surgery
  • Poor surgical outcomes have deterred patients from seeking treatment

These challenges could be met by the availability of more, well-trained health care practitioners – helping to address a major cause of preventable blindness in Africa.

This project focuses its efforts in Malawi and Uganda, where approximately 82,000 and 184,000 people, respectively, have cataract diagnoses and could benefit from an improvement in MSICS services.

Closing the gap: XOVA supports training to improve availability of care

Wet laboratories (wet labs) offer training with artificial eyes for trainees to practice and perfect the skills employed in ophthalmic surgery, prior to operating on patients. They are central to improving surgeons' confidence and technique – driving improved outcomes of surgery and helping encourage patients to consider treatment. Wet lab training programmes are not widely available in Africa, and with this award, XOVA sought to support such a cost-effective intiative.

Supported by a XOVA award in 2015, Orbis introduced wet lab training in MSICS to the University of Malawi Residency Training Programme and Makarere University of Uganda.

The key objectives of the wet lab training sessions were to:

  • Demonstrate proper techniques employed in ophthalmic surgery
  • Understand the names and uses of ophthalmic instruments
  • Practice eye–hand coordination under the operating microscope.

At each institution, the programme included a one-week intensive wet lab course, with a focus on MSICS, as well as time in theatre to further develop surgical skills. Residents then practiced their skills independently in the wet lab for at least 30 minutes per week throughout the duration of their residency course.

Wet lab training allows practice of essential skills and techniques used in MSICS, increasing the surgeon's confidence and yielding better surgery results

Wet lab training allows practice of essential skills and techniques used in MSICS, increasing the surgeon's confidence and yielding better surgery results

Malawi update: focused training yields rapid patient benefit

The University of Malawi training course featured an ophthalmic surgeon specialising in MSICS and a trained ophthalmic nurse. The training integrated didactic learning with workshops on critical diagnostic skills alongside practical learning courses in the theatre. The wet lab workshops provided opportunity for supervised practice to improve residents' understanding and technique at each of the stages of cataract surgery.

Importantly, this initiative yielded immediate benefit to the community – during the training programme a total of 15 patients received sight-saving cataract surgery.

The programme also included time for the university faculty to examine with the trainers the best ways to strengthen wet lab training for future use.

A physician at the University of Malawi performs MSICS on a patient.

A physician at the University of Malawi performs MSICS on a patient. During the wet lab training programme, 15 patients received vision-saving surgery

Uganda update: sharing best practice in sight-saving surgery

A successful hospital-based wet lab training programme has also been conducted at the Mbarara University of Science and Technology in Uganda. Along with MSICS, there was opportunity to develop surgical skills required in performing scleral tunnels, corneal and scleral laceration repairs, slip-knots and intraocular lens insertion.

The programme was attended by a total of 15 participants, comprising two faculty members and nine residents from Mbarara, and extended its reach to include four residents from Makerere University.

Resident team from Mbarara

Empowering residents to improve surgical outcomes in the treatment of cataract – the resident team