Posters

Recent experience of the VISION 2020 Links programme, Mulago Hospital, Kampala, Uganda

Poster Details

First Author: H.Orlans UK

Co Author(s):    H. Mehta   G. Ssali   C. Ateenyi-Agaba   C. Davey   R. Asaria  

Abstract Details

Purpose:

The purpose of this paper is to report on our recent experiences of the VISION 2020 LINK programme between the Royal Free Hospital London, UK and Mulago Hospital, Kampala, Uganda. We also aim to review the impact of the programme on the provision of eye care at the hospital since its establishment in 2009. To this end, we have focused on five key areas of practice: i. Ophthalmic nursing ii. Paediatric services iii. Glaucoma care iv. Medical and surgical retinal services with a particular emphasis on diabetic eye disease v. Training of medial students and ophthalmic residents We will first present the way in which care was delivered at Mulago prior to the commencement of the programme and then we will summarize the structure of the programme and the interventions it has orchestrated. Finally, we will discuss feedback from participants and the future aims of the partnership.

Setting:

Mulago National Referral Hospital is a public general and teaching hospital affiliated with the Makerere University College of Health Sciences. With over 1500 beds, it is the largest referral hospital in Uganda servicing a population in excess of 10 million. The eye department is staffed by ten ophthalmologists and has a dedicated clinic area, operating theatre and ward with 50 ophthalmic beds. The VISION 2020 LINK Programme is run by the International Centre for Eye Health at the London School of Hygiene & Tropical Medicine. The Mulago-Royal Free link was established in 2009 with the aim of improving eye care services in Uganda and fostering international cooperation in education, clinical practice and research, to the mutual benefit of the parties. Prior to the commencement of the LINK programme, there were no specifically trained ophthalmic nurses, with all eye clinics being supported by general ward nurses. Paediatric patients were seen together with adults in general clinics with no staff trained in refraction or orthoptics. There were no subspecialty glaucoma or retinal clinics, written case notes were not routinely used, and no postgraduate training in ophthalmology took place at Mulago hospital.

Methods:

The programme consisted of an annual visit of a multidisciplinary team made up of consultant and trainee ophthalmologists, orthoptists and nurses from the Royal Free Hospital to Mulago Hospital. During these visits, staff from both teams worked together in clinic seeing new and follow-up patients. A number of patients who were deemed to have complex ophthalmic problems were brought specifically to these clinics. Surgical techniques were also shared during theatre lists. During the visits, the London team delivered a series of lectures to the Makerere medical school on relevant topics such as diabetic retinopathy, glaucoma and HIV-related eye disease. Since the establishment of the LINK programme, a team from Mulago has visited the Royal Free at least once per year. Whilst in London, ophthalmologists from Mulago have received training in the use of lasers and observed clinics and theatre lists, whilst nursing staff have received training in refraction, children's visual acuity measurement, intra-ocular pressure measurement, refraction and orthoptics.

Results:

Through the Royal Free link, facilities at Mulago have been developed through the donation of equipment and consumables. To date, this includes an Argon laser machine, orthoptic equipment and diagnostic lenses. In the five key areas listed above the following developments have been achieved: i. Ophthalmic nursing. One dedicated ophthalmic nurse has been trained. A nurse-led cataract pre-assessment clinic has been established and nurses are now involved in triage of the patients who attend clinic. ii. Paediatric services. A dedicated paediatric ophthalmology clinic with its own waiting area now runs twice per week. This is attended by a paediatric ophthalmologist and a nurse who has been trained in paediatric refraction and orthoptics through the LINK programme. There are now two paediatric operating lists per week. iii. Glaucoma care. Subspecialty glaucoma clinics have been introduced and nursing staff have been trained in Perkins tonometry and Octopus visual field assessment. iv. Retinal Service. A dedicated retinal clinic has been established. The donated fundus lenses and laser machine have had limited use. v. Training. Two ophthalmic residents are now trained at Mulago.

Conclusions:

Since its establishment, the VISION 2020 LINK programme has overseen substantial and sustainable developments in the delivery of eye care in Kampala. The feedback from participants in the programme has been overwhelmingly positive. At the end of the most recent visit of the Royal Free team to Uganda in July 2013, sixteen members of staff from the department of Ophthalmology at Mulago completed a feedback questionnaire concerning the impact of the visit. All sixteen rated the training received as ‘Extremely relevant' or ‘Relevant' and were ‘Extremely likely' or ‘Likely' to recommend the programme to others. There is however much more that can be achieved by the programme in the future. Current potential aims include: i. Ophthalmic nursing. Establishing a nurse-led glaucoma follow-up clinic; formalizing the training of ophthalmic nursing through the introduction of a local diploma; continuing professional development programmes. ii. Paediatric services. Setting up a low vision service; public health campaign on squint/amblyopia; further training of staff in paediatric visual assessment, refraction and orthoptics. iii. Glaucoma care. Public health campaign/opportunistic screening; acquisition of equipment eg. cyclodiode laser, Humphrey fields machine, pachymeter, and associated training; introduction of antimetabolites in theatre and clinics. iv. Retinal Service. Further training on retinal laser techniques; establishment of a limited diabetic retinal screening service; training in vitreoretinal surgery. v. Training. Establishing a formal ophthalmic training programme with opportunity for subspecialisation. In summary, the VISION 2020 LINK between Mulago and the Royal Free hospitals has provided an opportunity for ophthalmologists and allied health professionals from both institutions to broaden their knowledge and skills base. Through the continued dedication and enthusiasm of ophthalmic professionals involved, the LINK programme and others like it will undoubtedly contribute to VISION 2020's ultimate aim of reducing the burden of preventable sight loss worldwide. FINANCIAL INTEREST: NONE