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Inside Eyetube.net | Jun 2011

Humanitarian Missions Focus on Improving Sight in Africa

Ophthalmology Worldwide was created in 2003 as a result of a request by Dieudonne Kaimbo Wa Kaimbo, MD, PhD, Professor of Ophthalmology at the University of Kinshasa, Democratic Republic of Congo, for assistance in developing the ophthalmology service at the university. Professor Kaimbo asked for materials and education for the medical staff in the latest ophthalmic surgical techniques. In response, a group of Belgian ophthalmologists, nurses, technicians, and logistics specialists have been going to Congo at least once a year since then to teach the medical staff and provide eye care to patients. Our work includes consultations, surgery, and providing refraction services and spectacles.

ABOUT CONGO

The population of the Democratic Republic of Congo was estimated to be 60.6 million in 2006. Poverty and an unemployment rate of 90% are responsible for many of the diseases that affect the citizens there. Due to the poor organization of health services, there is a severe lack of medical care and of eye care in particular.

The Congolese medical community is incapable of financing the sophisticated equipment that is required for practicing ophthalmology in the 21st century. Providing the most rudimentary care is a challenge, as the medical community struggles to respond to requests for treatment in urban centers. The situation is far more dire in remote areas.

ABOUT THE MISSIONS

Ophthalmology Worldwide conducts missions once a year for 2 to 3 weeks at two locations in Congo: the ophthalmology service at the University of Kinshasa and in Nioki, a dispensary of the Brothers of Charity in Bandundu Province, which is approximately 400 km east of Kinshasa. The Belgian participants are volunteers who pay for their own air transportation and personal expenses.

From the beginning, these missions have been conducted on a volunteer basis, and that is how they will continue. The volunteers consider the mission to be a humanitarian effort. Their motivation stems from the realization of the enormous needs of the Congolese; the number of blind and poorly sighted patients awaiting specialized care is staggering. Lodging and meals are provided by the Fathers de Scheut of St. Anne parish in Kinshasa and by the Brothers of Charity in Nioki.

Our educational efforts are fundamental, meaning we strive to equip the Congolese doctors with the ability to continue work begun by their Belgian colleagues. The ophthalmologists who participate in the program have experience in tropical pathology (Figure 1) and complicated surgery. Their technical experience and the financial backing they provide are essential building blocks of this project. Nursing personnel also participate in the program, and their teaching emphasize patient care, operating theater logistics, sterilization techniques, and management of supplies. In Nioki, our equipment has progressively been supplemented with biometry, phaco machines, and Nd:YAG lasers. Each year, we send the items needed because nothing is available locally.

Most of the surgical interventions we perform are cataract operations (Figure 2). Approximately 40% are done with phacoemulsification and 60% with extracapsular cataract extraction. We have recently started performing small-incision cataract surgery. Performing cataract surgery in Congo is challenging because all ofthe cataracts are mature, varying from snow white to dark brown. The anterior and posterior capsules are often calcified and fragile, and the zonules are weak with frequent subluxations. In 2010, we added an anesthesiologist to our group to facilitate surgeries for babies and young children with congenital cataracts.

Because glaucoma is also a major cause of blindness, we started a free glaucoma-screening clinic that is run by a nurse. All screened patients with elevated intraocular pressure (IOP) are automatically seen during the first week of consultations and are eventually treated.

Many patients arrive for the consultation with severe infections of the cornea and anterior segment. Most of these patients had been treated locally with herbs and traditional medications. When these conditions worsen, the patients plan the journey for a consultation, which sadly is often far too late for visual rehabilitation. Each year we see many patients with severe pathologies that affect their eye and general health due to the lack of eye and medical care in Congo; we see infections, traumas, or tumors that have progressed beyond treatment.

Congolese patients do not have access to opticians or optometrists. Therefore, we bring thousands of donated pairs of glasses to improve patients’ vision (Figure 3). This service is popular, and the demand increases each year.

ACCOMPLISHMENTS

Since the start of Ophthalmology Worldwide in 2003, a total of 12,756 consultations and 1,726 surgeries were performed in Kinshasa and Nioki by 2010 (Table 1), and 13 cataract missions will have been completed as of July 2011.

In Kinshasa, we have supplied the university’s ophthalmology service with modern equipment for its consultation and operating rooms, and we have donated the consumables and materials required to perform modern ocular surgery. We have taught theoretical and practical courses in cataract surgery, glaucoma, and infectious diseases of the eye to the local team. Our group has also conducted many patient consultations, performed cataract surgeries to help those blinded by cataracts, and donated spectacles.

The city of Nioki, with a population of approximately 45,000 people, is located in the Inongo Diocese, a Roman Catholic diocese with a population of more than 1 million covering 100,000 km2. The dispensary of the Brothers of Charity, where Ophthalmology Worldwide’s missions take place in Nioki, attracts patients from remote areas, at times more than 500 km from the city. Several months in advance of our arrival each year, the priests inform the inhabitants of all the parishes of the Inongo Diocese about our upcoming mission. Aside from radio, all other means of mass communication are lacking. Many patients make the long journey by canoe, bike, or foot to reach Nioki. Local transportation does not exist because there are no roads. Adding to the challenges, the state does not provide assistance to blind people.

The main mission of the Brothers of Charity is to treat patients with physical handicaps. Buildings belonging to the local Brothers of Charity community that are normally dedicated to this purpose are put at our disposal for the 2 to 3 weeks that we are in Nioki. These buildings provide the necessary workspace, including consulting rooms, an operating theater, an optical shop, and a reception bureau. The Brothers recognize the benefits of our efforts, and they participate fully in organizing our mission and are a tremendous help during consultations.

We will be returning to Nioki in October with a full team: seven ophthalmologists, two nurses, two opticians, one administrative assistant, and three assistants in ophthalmology attending Belgian universities.

Ophthalmology Worldwide has also devoted humanitarian efforts to help Dr. Richard Hardy, the only ophthalmologist in Mbuji-Mayi, a city of more than 2 million people in the Kasai province. We have supplied him with a phaco machine and a consultation unit to help him manage his huge workload. Our retina specialist has also given him a basic course in retinal surgery. In collaboration with the humanitarian organization Light for the World, two ophthalmologists and one nurse will return to Mbuji-Mayi in July for a 2-week cataract mission. We also will supply Dr. Hardy with optical machines to mount lenses in spectacle frames.

ACKNOWLEDGEMENTS

These missions cannot exist without assistance from commercial sponsors in the ophthalmologic sector in Belgium, especially our primary sponsor, Bausch + Lomb (Rochester, New York), along with Abbott Medical Optics Inc. (Santa Ana, California), Allergan, Inc. (Irvine, California), PhysIOL (Liége, Belgium), and Technop (Destelbergen, Belgium), that provide consumables, medications, and IOLs.

Editor’s Note: For information about Ophthalmology Worldwide, visit www.ophthalmologyworldwide.org.

Jacqueline Koller, MD, is President of Ophthalmology Worldwide. Dr. Koller states that she has no financial interest in the material presented in this article. She may be reached at tel: +32 68 285391; e-mail: jkoller@ophthalmologyworldwide.org.

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