Eyecare training for Nigerian doctors

Ophthalmologists in Nigeria will now take ROP (retinopathy of prematurity) seriously, thanks to a team of eyecare experts undergoing a vocational training programme (VTT) at Radhatri ­Nethralaya, an eye hospital in Chennai.

ROP is a potentially blinding disorder that affects preterm babies weighing less than 3 pounds at birth. It is one of the leading causes of preventable blindness in children worldwide, and yet largely neglected in developing countries, says Dr Vasumathy Vedantham, vitreoretinal surgeon and director of Radhatri Nethralaya. India is seeing epidemic levels of the disorder, because greater access to neonatal intensive care units has improved survival rates of premature infants, but without sophisticated oxygen regulation, she adds. Babies are more likely to get ROP if they get excess oxygen while being treated for breathing problems.

A four-member team from Nigeria comprising two optometrists, an ophthalmic nurse and an ophthalmologist underwent training at the hospital for ROP and other paediatric eye disorders. The VTT programme was arranged by RC ­Meenambakkam, RID 3234, through a global grant. The medical team was identified and supported by RC Ota, RID 9112. “A chance interaction in Dubai with Rtn Dr Wole Kukoyi of ­Nigeria while in transit for the Rotary convention in Houston resulted in this VTT,” says B ­Dakshayani, DRFC chair, RIDs 3233 and 3234. The training lasted for 15 days where the visiting team learned about ROP, squint and lazy eye syndromes, corneal opacities, allergies and childhood cataract. Dr Vasumathy, a member of RC Chennai Towers, led the training along with her husband, Dr Praveen Krishna, a paediatric ophthalmologist and squint specialist.

Highlighting the challenges related to paediatric eyecare in Nigeria, Solu Sotunde, team leader of the visiting group, says that awareness among caregivers on paediatric eye problems, especially ROP, is insufficient, and there are too few trained ophthalmologists and dedicated ROP coordinators.

“Africa’s situation today ­mirrors India’s a decade ago,” says Dr ­Vasumathy. She recalls that when she started ROP screening in ­Chennai “in 2007 there was no such programme in government hospitals here. ­Paediatricians would argue with me saying that there is no such thing as ROP in babies; you are wasting our time.” However, a landmark Supreme Court judgement awarding ₹3 crore compensation to a baby who was not screened for ROP changed the ­scenario and heightened awareness of the ­disorder. “But we still have a long way to go. We have only 150 ROP specialists in India.” She has trained seven teams in her hospital to identify and treat ROP. The treatment varies from laser to injections and surgery, depending on the severity of the disorder.

While laser treatment typically costs ₹40,000 for both the eyes, “we have subsidised it to ₹10,000. But we do not charge low-income parents because they come from government hospitals; if we ask them to pay they may refuse treatment for their baby,” she says. Rotary has supported the hospital with a GG in 2016 which helped treat 330 babies. To date, the hospital has treated 4,000 babies.

The visiting team was given hands-on lessons in identifying and treating various childhood eye disorders. They also participated in eye camps in the surrounding villages and schools for the differently-abled. “It has been an enlightening experience. In Nigeria we do not have much data. Coming to India has given us practical knowledge on how to do fieldwork, sensitise people and detect a problem at an initial stage,” says optometrist Dr Sharon Enemuoh.

Ophthalmologist Dr Ufuoma ­Olumodeji found “working in the OT, handling infants and babies, particularly instructive.” Dr Vasumathy taught her to use imaging devices to screen infants. “Ideally you need one-year training to screen and treat babies with ROP. Infants are not given anaesthesia and their eyes are so very delicate. ­Special skill is required to hold the baby, use the camera on the eyes, check the monitor and record the findings,” she says. The VTT provided new learning opportunities for Mira Akpakpan, an ophthalmic nurse who “has never been exposed to preterm babies.”

The visit to India was a first for all the team members. Sharon loved the beach and the Indian culture. As for food, she loved the local chicken biryani while Mira enjoyed chicken fried rice. Solu was “blown by the hospitality of the Rotarians. We visited a couple of Rotary clubs and everyone was polite and helpful.”

This is the second VTT project of RC Meenambakkam, the earlier one being a paediatric cardiology training programme at the Madras Medical ­Mission Hospital for a team from Uganda.